Organization
TAMPA BAY ORTHOPAEDIC DESIGNS, INC.
Active
Parent organization
TAMPA BAY ORTHOPAEDIC DESIGNS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TAMPA BAY ORTHOPAEDIC DESIGNS INC
Authorized official
OLAF MICKLE HOLM PROSTHETIST/ORTHOTIS (PRESIDENT)
(813) 661-9162
Entity
Organization
Contact information
Practice address
667 S KINGS AVE, BRANDON, FL 33511-4885
(813) 661-9162
(813) 662-9347
Mailing address
667 S KINGS AVE, BRANDON, FL 33511-6048
(813) 661-9162
(813) 662-9347
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR124
FL
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861685083
NPI
FL
01
—
M2713
BC/BS OF FL
FL
Enumeration date
08/21/2007
Last updated
11/27/2023
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