# ORTHOPEDIC CENTER FOR SPORTS MEDICINE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831521756
- **Authorized official:** MR. ROBERT MATHIS (ADMINISTRATOR)
- **Authorized official phone:** (863) 421-7411

## Contact information

- **Practice address:** 105 PARK PLACE BLVD, SUITE A, DAVENPORT, FL 33837-6858
- **Practice address phone:** (863) 421-7411
- **Practice address fax:** (863) 547-9514
- **Mailing address:** 105 PARK PLACE BLVD, SUITE A, DAVENPORT, FL 33837-6858
- **Mailing address phone:** (863) 421-7411
- **Mailing address fax:** (863) 547-9514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | ME72924 | FL | Yes |

## Other

- **Enumeration date:** 08/01/2013
- **Last updated:** 01/19/2016