Provider Demographics
NPI:1346263548
Name:CHOI HANFF MIRABELLO SHIM & TORKE
Entity Type:Organization
Organization Name:CHOI HANFF MIRABELLO SHIM & TORKE
Other - Org Name:FLORIDA SPORTS ORTHOPAEDIC AND SPINE MEDICINE CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-787-5577
Mailing Address - Street 1:3890 TAMPA RD
Mailing Address - Street 2:STE 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-787-5577
Mailing Address - Fax:
Practice Address - Street 1:3890 TAMPA RD
Practice Address - Street 2:STE 202
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-787-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264324301Medicaid
FL264324301Medicaid