Provider Demographics
NPI:1700100179
Name:WESTCHASE SPORTS MEDICINE ORTHOPAEDICS, LLC.
Entity type:Organization
Organization Name:WESTCHASE SPORTS MEDICINE ORTHOPAEDICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MACLAREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-855-8450
Mailing Address - Street 1:11301 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2610
Mailing Address - Country:US
Mailing Address - Phone:813-855-8450
Mailing Address - Fax:813-855-7540
Practice Address - Street 1:11301 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2610
Practice Address - Country:US
Practice Address - Phone:813-855-8450
Practice Address - Fax:813-855-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100433207XS0117X
FLOS8857207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty