Provider Demographics
NPI:1760517890
Name:PREMIER MILLER ORTHOPEDIC CENTERS INC
Entity Type:Organization
Organization Name:PREMIER MILLER ORTHOPEDIC CENTERS INC
Other - Org Name:OUTPATIENT TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-376-2841
Mailing Address - Street 1:25306 OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5547
Mailing Address - Country:US
Mailing Address - Phone:813-907-7852
Mailing Address - Fax:813-856-4587
Practice Address - Street 1:400 E DR M L KING JR BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3836
Practice Address - Country:US
Practice Address - Phone:813-238-6510
Practice Address - Fax:813-237-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP04000038336261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center