# CHARLOTTE ORTHOPAEDIC CLINIC PROFESSIONAL ASSOCIATION

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

## Provider details

- **NPI number:** 1952350977
- **Authorized official:** MS. ELIZABETH RENEE MCLURE (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (941) 625-0984

## Contact information

- **Practice address:** 4161 TAMIAMI TRL, UNIT 101, PORT CHARLOTTE, FL 33952-9204
- **Practice address phone:** (941) 625-0984
- **Practice address fax:** (941) 625-0877
- **Mailing address:** 4161 TAMIAMI TRL, UNIT 101, PORT CHARLOTTE, FL 33952-9204
- **Mailing address phone:** (941) 625-0984
- **Mailing address fax:** (941) 625-0877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/08/2006
- **Last updated:** 08/05/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0886990001 | PALMETTO | FL |
| 01 | — | 1596302000 | DEPT OF LABOR | FL |
| 01 | — | 4639456 | AETNA | FL |
| 01 | — | 7323528-002 | CIGNA-PAL | FL |
| 01 | — | 77674 | BLUE CROSS BLUE SHIELD | FL |
| 01 | — | DE0219 | RR MEDICARE | FL |
| 01 | — | K2675 | MEDICARE | FL |