Provider Demographics
NPI:1861794208
Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE CENTER P.A.
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-672-7850
Mailing Address - Street 1:141 SAGEBRUSH TRL
Mailing Address - Street 2:STE C
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8115
Mailing Address - Country:US
Mailing Address - Phone:386-672-7850
Mailing Address - Fax:386-673-8606
Practice Address - Street 1:141 SAGEBRUSH TRL
Practice Address - Street 2:STE C
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8115
Practice Address - Country:US
Practice Address - Phone:386-672-7850
Practice Address - Fax:386-673-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty