Healthcare Provider Details

I. General information

NPI: 1467589010
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: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 MAR WALT DR UNIT 100
FORT WALTON BEACH FL
32547-6637
US

IV. Provider business mailing address

PO BOX 740923
ATLANTA GA
30374-0923
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ANGELA GRIESE
Title or Position: SOFTWARE SUPPORT/CONTRACT MANAGER
Credential:
Phone: 850-863-2153