Basic Information
| Provider Information | |||||||||
| NPI: | 1093063869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCALA HEALTH TRAUMA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 SE 14TH PL | ||||||||
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| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291800 | ||||||||
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| Address1: | 205 SE 14TH PL | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344714341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291800 | ||||||||
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| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | PICKLER | ||||||||
| AuthorizedOfficialFirstName: | MICKEY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8505232117 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.