Provider Demographics
NPI:1740507755
Name:ORTHOPEDIC & RADIOLOGY CENTER INC
Entity type:Organization
Organization Name:ORTHOPEDIC & RADIOLOGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO LAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-880-7577
Mailing Address - Street 1:5406 HOOVER BLVD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5330
Mailing Address - Country:US
Mailing Address - Phone:813-880-7577
Mailing Address - Fax:813-880-7553
Practice Address - Street 1:5406 HOOVER BLVD
Practice Address - Street 2:SUITE 18
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5330
Practice Address - Country:US
Practice Address - Phone:813-880-7577
Practice Address - Fax:813-880-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7378261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center