Provider Demographics
NPI:1811404155
Name:THE CENTER FOR BONE AND JOINT DISEASE, PA
Entity type:Organization
Organization Name:THE CENTER FOR BONE AND JOINT DISEASE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-857-4397
Mailing Address - Street 1:7544 JACQUE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7162
Mailing Address - Country:US
Mailing Address - Phone:727-697-2200
Mailing Address - Fax:
Practice Address - Street 1:16506 POINTE VILLAGE DR STE 109
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5255
Practice Address - Country:US
Practice Address - Phone:727-605-3808
Practice Address - Fax:352-503-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255796700Medicaid
FL38329OtherBCBS