Provider Demographics
NPI:1194400036
Name:THE ORTHOPAEDIC INSTITUTE, PA
Entity type:Organization
Organization Name:THE ORTHOPAEDIC INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-336-6000
Mailing Address - Street 1:4500 NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2245
Mailing Address - Country:US
Mailing Address - Phone:352-336-6000
Mailing Address - Fax:
Practice Address - Street 1:7824 LAKE UNDERHILL RD STE H
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8201
Practice Address - Country:US
Practice Address - Phone:352-336-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ORTHOPAEDIC INSTITUTE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-19
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty