1467589010 NPI number — ORTHOPAEDIC ASSOCIATES, PA

Table of content: (NPI 1467589010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467589010 NPI number — ORTHOPAEDIC ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC ASSOCIATES, PA
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:
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:
1467589010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740923
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-0923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-863-2153
Provider Business Mailing Address Fax Number:
850-315-9350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 MAR WALT DR UNIT 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-6637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-863-2153
Provider Business Practice Location Address Fax Number:
850-315-9350
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRIESE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOFTWARE SUPPORT/CONTRACT MANAGER
Authorized Official Telephone Number:
850-863-2153

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1467589010 . This is a "MEDICARE NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002879600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467589010 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467589010 . This is a "MEDICARE NPI GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DC690A . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 112046500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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