Provider Demographics
NPI:1780648089
Name:COMBINED MEDICAL SERVICES GROUP INC
Entity Type:Organization
Organization Name:COMBINED MEDICAL SERVICES GROUP INC
Other - Org Name:PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS CPO
Authorized Official - Phone:407-622-7200
Mailing Address - Street 1:1455 GENE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4840
Mailing Address - Country:US
Mailing Address - Phone:407-622-7200
Mailing Address - Fax:407-622-7528
Practice Address - Street 1:1455 GENE ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4840
Practice Address - Country:US
Practice Address - Phone:407-622-7200
Practice Address - Fax:407-622-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR52222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1209120002Medicare ID - Type Unspecified