Provider Demographics
NPI:1902667256
Name:WATSON CLINIC LLP
Entity Type:Organization
Organization Name:WATSON CLINIC LLP
Other - Org Name:WATSON CLINIC WINTER HAVEN ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSBRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-680-7007
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3065
Mailing Address - Country:US
Mailing Address - Phone:863-680-7810
Mailing Address - Fax:
Practice Address - Street 1:100 AVENUE I NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4143
Practice Address - Country:US
Practice Address - Phone:863-680-7214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty