Provider Demographics
NPI:1235990540
Name:STAR ORTHOPEDICS AND SPINE OF ORLANDO LLC.
Entity Type:Organization
Organization Name:STAR ORTHOPEDICS AND SPINE OF ORLANDO LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-699-6373
Mailing Address - Street 1:2130 MICHIGAN AVE.
Mailing Address - Street 2:PMB 312
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744
Mailing Address - Country:US
Mailing Address - Phone:561-699-6373
Mailing Address - Fax:
Practice Address - Street 1:280 S STATE ROAD 434 STE 1049
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3859
Practice Address - Country:US
Practice Address - Phone:561-699-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty