Provider Demographics
NPI:1427104454
Name:ORTHOPAEDIC SPECIALTY CARE LLC
Entity type:Organization
Organization Name:ORTHOPAEDIC SPECIALTY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-624-0004
Mailing Address - Street 1:2685 SW 32ND PL STE 400
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7866
Mailing Address - Country:US
Mailing Address - Phone:352-624-0004
Mailing Address - Fax:352-624-3090
Practice Address - Street 1:2685 SW 32ND PL STE 400
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7866
Practice Address - Country:US
Practice Address - Phone:352-624-0004
Practice Address - Fax:352-624-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73474207X00000X
FLOT8468225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252721900Medicaid
DF7751OtherMEDICARE RAILROAD
DF7751OtherMEDICARE RAILROAD
FLAC387Medicare PIN
FLG07752Medicare UPIN