1053477687 NPI number — KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053477687 NPI number — KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES
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:
KENNEDY-WHITE ORTHOPAEDIC CENTER
Provider Other Organization Name Type Code:
3
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:
1053477687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6050 CATTLERIDGE BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34232-6014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-365-0655
Provider Business Mailing Address Fax Number:
941-366-8043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6050 CATTLERIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232-6014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-365-0655
Provider Business Practice Location Address Fax Number:
941-366-8043
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'NEAL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
941-365-0655

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4961480001 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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