Provider Demographics
NPI:1073898227
Name:OA CENTERS OF FLORIDA, LLC.
Entity Type:Organization
Organization Name:OA CENTERS OF FLORIDA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-399-1112
Mailing Address - Street 1:29 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7531
Mailing Address - Country:US
Mailing Address - Phone:239-791-8173
Mailing Address - Fax:239-791-8256
Practice Address - Street 1:29 BARKLEY CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7531
Practice Address - Country:US
Practice Address - Phone:239-791-8173
Practice Address - Fax:239-791-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00405532081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFW628AOtherMEDICARE PTAN
FLFW628AOtherMEDICARE PTAN