Provider Demographics
NPI:1891779377
Name:CHOI HANFF MIRABELLO SHIM & TORKE
Entity Type:Organization
Organization Name:CHOI HANFF MIRABELLO SHIM & TORKE
Other - Org Name:FLORIDA JOINT REPLACEMENT & SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-787-5577
Mailing Address - Street 1:5243 HANFF LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4226
Mailing Address - Country:US
Mailing Address - Phone:727-848-4249
Mailing Address - Fax:727-841-8934
Practice Address - Street 1:5243 HANFF LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4226
Practice Address - Country:US
Practice Address - Phone:727-848-4249
Practice Address - Fax:727-841-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5612Medicare ID - Type Unspecified