Provider Demographics
NPI:1437185444
Name:SANDHILL BONE & JOINT INC
Entity Type:Organization
Organization Name:SANDHILL BONE & JOINT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-754-0817
Mailing Address - Street 1:P.O. BOX 2065
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33564
Mailing Address - Country:US
Mailing Address - Phone:813-754-0817
Mailing Address - Fax:813-707-1977
Practice Address - Street 1:511 W ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563
Practice Address - Country:US
Practice Address - Phone:813-754-0817
Practice Address - Fax:813-707-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8868207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34683OtherBC/BS
FL469180OtherTRICARE
FLDB7781OtherRAILROAD MEDICARE
FL064698901Medicaid
FL064698901Medicaid
FLK2765Medicare UPIN