Provider Demographics
NPI:1841297538
Name:OCALA ORTHOPAEDIC GROUP PA
Entity type:Organization
Organization Name:OCALA ORTHOPAEDIC GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:REGISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-401-3127
Mailing Address - Street 1:1015 SE 17TH ST
Mailing Address - Street 2:#100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3968
Mailing Address - Country:US
Mailing Address - Phone:352-401-3127
Mailing Address - Fax:352-351-9129
Practice Address - Street 1:1015 SE 17TH ST
Practice Address - Street 2:STE 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3920
Practice Address - Country:US
Practice Address - Phone:352-351-3422
Practice Address - Fax:352-351-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253442800Medicaid
FL0294090001Medicare NSC
FL253442800Medicaid