Provider Demographics
NPI:1558116913
Name:ADVANCED ORTHOPEDICS INSTITUTE, P.A.
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS INSTITUTE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-775-4017
Mailing Address - Street 1:13696 N US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6814
Mailing Address - Country:US
Mailing Address - Phone:352-751-1221
Mailing Address - Fax:833-449-3916
Practice Address - Street 1:13696 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6814
Practice Address - Country:US
Practice Address - Phone:352-751-1221
Practice Address - Fax:833-449-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003708700Medicaid
FL1790745164OtherNPPES