Provider Demographics
NPI:1285017855
Name:ADVANCED ORTHOPEDIC SURGERY
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-318-9696
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33839-0490
Mailing Address - Country:US
Mailing Address - Phone:863-318-9696
Mailing Address - Fax:863-318-8075
Practice Address - Street 1:250 3RD ST NW
Practice Address - Street 2:SUITE 201
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4605
Practice Address - Country:US
Practice Address - Phone:863-318-9696
Practice Address - Fax:863-318-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF59694Medicare UPIN