Provider Demographics
NPI:1821163270
Name:RADNOTHY ORTHOPAEDICS, PA
Entity Type:Organization
Organization Name:RADNOTHY ORTHOPAEDICS, PA
Other - Org Name:RADNOTHY PERRY ORTHOPAEDIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:H
Authorized Official - Last Name:RADNOTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-343-2171
Mailing Address - Street 1:2051 MAYO DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778
Mailing Address - Country:US
Mailing Address - Phone:352-343-2171
Mailing Address - Fax:352-343-1475
Practice Address - Street 1:2051 MAYO DRIVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778
Practice Address - Country:US
Practice Address - Phone:352-343-2171
Practice Address - Fax:352-343-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL056686207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI8654OtherRAILROAD MEDICARE
FLK0825Medicare PIN
FL80836AMedicare ID - Type Unspecified
F27415Medicare UPIN