Healthcare Provider Details

I. General information

NPI: 1124155783
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36474 EMERALD COAST PARKWAY BUILDING C SUITE 3101
DESTIN FL
32541-4713
US

IV. Provider business mailing address

PO BOX 740923
ATLANTA GA
30374-0923
US

V. Phone/Fax

Practice location:
  • Phone: 508-632-1538
  • Fax: 850-315-9350
Mailing address:
  • Phone: 850-863-2153
  • Fax: 850-315-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA ARCHIE
Title or Position: BILLING MANAGER
Credential:
Phone: 850-863-2153