1912932047 NPI number — ORTHOPEDIC CENTER OF FLORIDA, INC

Table of content: (NPI 1912932047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912932047 NPI number — ORTHOPEDIC CENTER OF FLORIDA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC CENTER OF FLORIDA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912932047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12670 CREEKSIDE LANE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33919-8759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-482-2663
Provider Business Mailing Address Fax Number:
239-482-7585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12670 CREEKSIDE LANE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33919-8759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-482-2663
Provider Business Practice Location Address Fax Number:
239-482-7585
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
239-482-2663

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K0865 . This is a "MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00231 . This is a "GROUP BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265840200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0670070001 . This is a "MEDICARE DME" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265840200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com