1649547084 NPI number — ORTHOPEDIC ASSOCIATES, PA

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 1649547084 NPI number — ORTHOPEDIC ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC 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:
1649547084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 N ATLANTIC AVE
Provider Second Line Business Mailing Address:
SUITE 603
Provider Business Mailing Address City Name:
COCOA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32931-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-459-1446
Provider Business Mailing Address Fax Number:
321-452-1261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 N SYKES CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MERRITT ISLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32953-3489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-459-1446
Provider Business Practice Location Address Fax Number:
321-452-1261
Provider Enumeration Date:
11/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GUZMAN
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/SURGEON
Authorized Official Telephone Number:
321-459-1446

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)





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