MEDICARE: ORTHOCLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0000000000	OTHER	FL	BCBS PROVIDER #
3	0000000000	OTHER	FL	TRICARE PROVIDER #

General Provider Information

NPI Number	:	1730587585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOCLINIC, INC.

Provider Business Mailing Address
First Line	:	2315 RUTH HENTZ AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2260
Country	:	US
Telephone Number	:	850-630-5402
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 RUTH HENTZ AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2260
Country	:	US
Telephone Number	:	850-630-5402
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CAROL DAVIS
Credential	:
Telephone Number	:	850-630-5402

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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Directions to “ORTHOCLINIC, INC. ” Practice Location

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