Provider Demographics
NPI:1588001127
Name:FLORIDA MUSCULOSKELETAL SURGICAL GROUP LLC
Entity Type:Organization
Organization Name:FLORIDA MUSCULOSKELETAL SURGICAL GROUP LLC
Other - Org Name:ORTHOPAEDIC SPECIALTIES OF TAMPA BAY DME
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-369-5037
Mailing Address - Street 1:1011 JEFFORDS ST STE C&D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 JEFFORDS ST STE C&D
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4070
Practice Address - Country:US
Practice Address - Phone:727-446-5993
Practice Address - Fax:727-446-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies