Provider Demographics
NPI:1073652665
Name:N FLA SPORTS MEDICINE AND ORTHOPAEDIC CENTER PA
Entity Type:Organization
Organization Name:N FLA SPORTS MEDICINE AND ORTHOPAEDIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-878-2549
Mailing Address - Street 1:1911 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5321
Mailing Address - Country:US
Mailing Address - Phone:850-878-2549
Mailing Address - Fax:850-212-9334
Practice Address - Street 1:1911 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5321
Practice Address - Country:US
Practice Address - Phone:850-878-2549
Practice Address - Fax:850-878-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0900130001Medicare NSC
FL520392Medicare PIN