Provider Demographics
NPI:1891008017
Name:CHILDREN'S ORTHOPAEDIC AND SCOLIOSIS SURGERY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:CHILDREN'S ORTHOPAEDIC AND SCOLIOSIS SURGERY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ITTIG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMPE
Authorized Official - Phone:727-568-6840
Mailing Address - Street 1:625 6TH AVENUE SOUTH
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4629
Mailing Address - Country:US
Mailing Address - Phone:727-898-2663
Mailing Address - Fax:727-568-6836
Practice Address - Street 1:3440 W DR. MLK JR. BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6214
Practice Address - Country:US
Practice Address - Phone:813-879-2663
Practice Address - Fax:813-872-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375965208Medicaid
33111Medicare PIN