Provider Demographics
NPI:1154759512
Name:ORTHOPAEDIC ASSOCIATES OF WEST FLORIDA, PA
Entity type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF WEST FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-6026
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3398
Mailing Address - Country:US
Mailing Address - Phone:727-461-6026
Mailing Address - Fax:727-461-7446
Practice Address - Street 1:8839 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1203
Practice Address - Country:US
Practice Address - Phone:727-461-6026
Practice Address - Fax:727-397-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1014Medicare PIN
FL0455690001Medicare NSC