Organization
FLORIDA SPORTS MEDICINE INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN HASELTINE (C.E.O.)
(904) 823-3764
Entity
Organization
Contact information
Practice address
150 SOUTHPARK BLVD, SUITE 102, ST AUGUSTINE, FL 32086-5190
(904) 823-3764
(904) 429-0318
Mailing address
150 SOUTHPARK BLVD, SUITE 102, ST AUGUSTINE, FL 32086-5190
(904) 823-3764
(904) 429-0318
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
ME93573
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
OS7217
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00728
BLUE CROSS GROUP
FL
Enumeration date
09/25/2006
Last updated
01/05/2017
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