Provider Demographics
NPI:1508872839
Name:JOINT IMPLANT SURGEONS OF FLORIDA PA
Entity Type:Organization
Organization Name:JOINT IMPLANT SURGEONS OF FLORIDA PA
Other - Org Name:JOINT IMPLANT SURGEONS OF FLORIDA, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HUMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-337-2003
Mailing Address - Street 1:7331 COLLEGE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5524
Mailing Address - Country:US
Mailing Address - Phone:239-337-2003
Mailing Address - Fax:239-337-3168
Practice Address - Street 1:7331 COLLEGE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5524
Practice Address - Country:US
Practice Address - Phone:239-337-2003
Practice Address - Fax:239-337-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20188693OtherMEDICARE RAILROAD
FL38222OtherBCBS
0667439OtherAETNA
0667439OtherAETNA
FLK0352Medicare PIN