1437185444 NPI number — SANDHILL BONE & JOINT INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437185444 NPI number — SANDHILL BONE & JOINT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDHILL BONE & JOINT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437185444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANT CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-754-0817
Provider Business Mailing Address Fax Number:
813-707-1977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 W ALEXANDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-754-0817
Provider Business Practice Location Address Fax Number:
813-707-1977
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OTT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
813-754-0817

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  OS8868 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34683 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 469180 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DB7781 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 064698901 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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