Provider Demographics
NPI:1659254456
Name:CELEBRATION ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE INC
Entity type:Organization
Organization Name:CELEBRATION ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-939-0222
Mailing Address - Street 1:2954 MALLORY CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1822
Mailing Address - Country:US
Mailing Address - Phone:908-208-1290
Mailing Address - Fax:
Practice Address - Street 1:6718 LAKE NONA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7984
Practice Address - Country:US
Practice Address - Phone:321-939-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CELEBRATION ORTHOPAEDIC AND SPORTS MEDICINE INSTITUTE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty