Provider Demographics
NPI:1174685044
Name:CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
Other - Org Name:THE CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEHSERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-497-2663
Mailing Address - Street 1:1525 TAMIAMI TRL S
Mailing Address - Street 2:STE 602
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3568
Mailing Address - Country:US
Mailing Address - Phone:941-497-2663
Mailing Address - Fax:941-497-5960
Practice Address - Street 1:1525 TAMIAMI TRL S
Practice Address - Street 2:STE 602
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3568
Practice Address - Country:US
Practice Address - Phone:941-497-2663
Practice Address - Fax:941-497-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB6554OtherRAILROAD MEDICARE GRP PIN
FL00173Medicare PIN
FL0638520001Medicare NSC