Provider Demographics
NPI:1710869243
Name:CELEBRATION ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE INC
Entity type:Organization
Organization Name:CELEBRATION ORTHOPEDIC AND SPORTS MEDICINE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-939-0222
Mailing Address - Street 1:2954 MALLORY CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1822
Mailing Address - Country:US
Mailing Address - Phone:321-939-0222
Mailing Address - Fax:321-939-0225
Practice Address - Street 1:173 N CHARLES RICHARD BEALL BLVD STE 106
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2211
Practice Address - Country:US
Practice Address - Phone:321-939-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CELEBRATION ORTHOPAEDIC & SPORTS MEDICINE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty