Provider Demographics
NPI:1366927170
Name:ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Entity type:Organization
Organization Name:ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:U
Authorized Official - Last Name:ARANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-324-6100
Mailing Address - Street 1:23781 US HIGHWAY 27 STE 122
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1526 COMMERCIAL PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6568
Practice Address - Country:US
Practice Address - Phone:863-324-6100
Practice Address - Fax:863-679-9182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL PALM ORTHOPEDIC & SPORTS MEDICINE INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280899400Medicaid