1487896213 NPI number — ORTHOPAEDIC SPINE & FRACTURE OF PALM BEACH, LLC

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 1487896213 NPI number — ORTHOPAEDIC SPINE & FRACTURE OF PALM BEACH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC SPINE & FRACTURE OF PALM BEACH, LLC
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:
1487896213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8136 OKEECHOBEE BLVD STE A&B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33411-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-242-1174
Provider Business Mailing Address Fax Number:
561-242-1197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1019 N STATE ROAD 7 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-296-2345
Provider Business Practice Location Address Fax Number:
561-296-2346
Provider Enumeration Date:
03/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
QURAESHI
Authorized Official First Name:
SHAHMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF FINANCIAL OFFICER
Authorized Official Telephone Number:
561-242-1174

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  ME81924 , 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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