MEDICARE: PREMIER MILLER ORTHOPEDIC CENTERS 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	P04000038336	FL

General Provider Information

NPI Number	:	1760517890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER MILLER ORTHOPEDIC CENTERS INC

Provider Business Mailing Address
First Line	:	25306 OAKS BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5547
Country	:	US
Telephone Number	:	813-907-7852
Fax Number	:	813-856-4587

Provider Business Practice Location Address
First Line	:	400 E DR M L KING JR BLVD
Second Line	:	SUITE 104
City	:	TAMPA
State	:	FL
Zip	:	33603-3836
Country	:	US
Telephone Number	:	813-238-6510
Fax Number	:	813-237-2424

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. SHERRY A MILLER
Credential	:
Telephone Number	:	813-376-2841

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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