Provider Demographics
NPI:1770684193
Name:ORTHOPAEDIC SPECIALTIES OF TAMPA BAY INC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALTIES OF TAMPA BAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:727-446-5993
Mailing Address - Street 1:1011 JEFFORDS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4070
Mailing Address - Country:US
Mailing Address - Phone:727-446-5993
Mailing Address - Fax:727-446-4477
Practice Address - Street 1:1011 JEFFORDS ST
Practice Address - Street 2:SUITE C
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:2006-09-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263862200Medicaid
FL74701OtherGROUP BC/BS PROVIDER NUMB
FLK8610Medicare PIN
FL263862200Medicaid