Provider Demographics
NPI:1437186236
Name:THE CENTER FOR BONE AND JOINT DISEASE, PA
Entity Type:Organization
Organization Name:THE CENTER FOR BONE AND JOINT DISEASE, PA
Other - Org Name:FLORIDA ORTHOPAEDIC TRAUMA SPECIALISTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENNETT, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-697-2200
Mailing Address - Street 1:7544 JACQUE ROAD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7162
Mailing Address - Country:US
Mailing Address - Phone:727-697-2200
Mailing Address - Fax:727-863-8774
Practice Address - Street 1:7544 JACQUE ROAD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7162
Practice Address - Country:US
Practice Address - Phone:727-697-2200
Practice Address - Fax:727-863-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X, 208100000X, 225100000X, 363A00000X
FL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38329OtherBCBS
FL120926200Medicaid
FL0613080001Medicare NSC
FLK0634Medicare UPIN
FL0613080002Medicare NSC
FLK0634AMedicare PIN
FL0613080003Medicare NSC
FLC31159Medicare PIN
FL255796700Medicaid