Provider Demographics
NPI:1457458317
Name:CENTRAL FLORIDA ORTHOPAEDIC SURGERY ASSOCIATES PL
Entity Type:Organization
Organization Name:CENTRAL FLORIDA ORTHOPAEDIC SURGERY ASSOCIATES PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:863-666-3436
Mailing Address - Street 1:2000 E EDGEWOOD DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3653
Mailing Address - Country:US
Mailing Address - Phone:863-666-3436
Mailing Address - Fax:863-667-3550
Practice Address - Street 1:2000 E EDGEWOOD DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3653
Practice Address - Country:US
Practice Address - Phone:863-666-3436
Practice Address - Fax:863-667-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76265207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC2168OtherRAILROAD MEDICARE
FL6419019001OtherCIGNA
FL7287263OtherAETNA
FL1844429OtherUNITED HEALTH CARE
FL1994OtherAVMED
FL43865OtherBCBS
FL43865OtherBCBS
FLDC2168OtherRAILROAD MEDICARE
FLG84574Medicare UPIN