Provider Demographics
NPI:1124016175
Name:CENTRAL ORTHOPEDICS PA
Entity Type:Organization
Organization Name:CENTRAL ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-299-5667
Mailing Address - Street 1:222 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-6311
Mailing Address - Country:US
Mailing Address - Phone:863-299-5667
Mailing Address - Fax:863-299-7722
Practice Address - Street 1:222 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6311
Practice Address - Country:US
Practice Address - Phone:863-299-5667
Practice Address - Fax:863-299-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL990523500OtherENVOY
FL99538OtherPRUDENTIAL
FL342990001OtherDMERC/PGBA
FL=========OtherDELTA-QHP
FL=========Medicaid
FL=========OtherCITRUS HEALTHCARE MEDICAR
FL=========OtherRR MEDICARE
FL=========OtherUNIVERSAL HEALTHCARE
FL=========OtherHUMANA
FL=========OtherTRI CARE
FL=========OtherWELLCARE MEDICARE
FL990523500OtherENVOY
FL=========OtherUHC
FL99538OtherPRUDENTIAL
FL=========OtherFLORIDA FIRST
FL=========OtherBCBS
FL=========OtherCIGNA
FL=========OtherBCBS
FL=========OtherUHC
FL342990001OtherDMERC/PGBA