Provider Demographics
NPI:1023882164
Name:THE ORTHOPAEDIC INSTITUTE PA
Entity type:Organization
Organization Name:THE ORTHOPAEDIC INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-336-6000
Mailing Address - Street 1:4500 NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:
Practice Address - Street 1:830 EXECUTIVE LN STE 120
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3595
Practice Address - Country:US
Practice Address - Phone:321-639-2551
Practice Address - Fax:321-504-6260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ORTHOPAEDIC INSTITUTE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty