Provider Demographics
NPI:1306172259
Name:SEVEN RIVERS ORTHOPAEDIC & SPORTS MEDICINE, PA
Entity type:Organization
Organization Name:SEVEN RIVERS ORTHOPAEDIC & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-249-7080
Mailing Address - Street 1:PO BOX 640573
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0573
Mailing Address - Country:US
Mailing Address - Phone:352-465-5663
Mailing Address - Fax:352-465-5664
Practice Address - Street 1:10495 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-465-5663
Practice Address - Fax:352-465-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111270OtherBCBS TN