Provider Demographics
NPI:1518135300
Name:ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Entity Type:Organization
Organization Name:ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Other - Org Name:ROYAL PALM ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-324-6100
Mailing Address - Street 1:23781 US HIGHWAY 27
Mailing Address - Street 2:SUITE 122
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7802
Mailing Address - Country:US
Mailing Address - Phone:863-324-6100
Mailing Address - Fax:863-679-9182
Practice Address - Street 1:1120 CARLTON AVE STE 1400
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4347
Practice Address - Country:US
Practice Address - Phone:863-324-6100
Practice Address - Fax:863-679-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64942207X00000X, 207XX0005X
207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280899400Medicaid
FL280899400Medicaid