Basic Information
| Provider Information | |||||||||
| NPI: | 1396114138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARASOTA ORTHOPEDIC ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 BAHIA VISTA ST | ||||||||
| Address2: | 100 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342392600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419512663 | ||||||||
| FaxNumber: | 9415523312 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 COMMERCIAL CT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342921658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419512663 | ||||||||
| FaxNumber: | 9415523312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | JUSTICE | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING AND COLLECTIONS | ||||||||
| AuthorizedOfficialTelephone: | 9419512663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0117X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XX0004X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 213ES0103X | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 061701600 | 05 | FL | MEDICAID |