MEDICARE: ORTHOPEDIC & RADIOLOGY CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	HCC7378	FL

General Provider Information

NPI Number	:	1740507755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC & RADIOLOGY CENTER INC

Provider Business Mailing Address
First Line	:	5406 HOOVER BLVD
Second Line	:	SUITE 18
City	:	TAMPA
State	:	FL
Zip	:	33634-5330
Country	:	US
Telephone Number	:	813-880-7577
Fax Number	:	813-880-7553

Provider Business Practice Location Address
First Line	:	5406 HOOVER BLVD
Second Line	:	SUITE 18
City	:	TAMPA
State	:	FL
Zip	:	33634-5330
Country	:	US
Telephone Number	:	813-880-7577
Fax Number	:	813-880-7553

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EDUARDO DELGADO LAGO
Credential	:
Telephone Number	:	813-880-7577

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	04/29/2010

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