Healthcare Provider Details

I. General information

NPI: 1174998629
Provider Name (Legal Business Name): TFPS IV, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W BROWARD BLVD STE 200
FT LAUDERDALE FL
33312-1417
US

IV. Provider business mailing address

9960 CENTRAL PARK BLVD N STE 400
BOCA RATON FL
33428-1759
US

V. Phone/Fax

Practice location:
  • Phone: 954-792-1010
  • Fax: 954-792-1199
Mailing address:
  • Phone: 561-288-5500
  • Fax: 561-482-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA MCCAULEY
Title or Position: CEO
Credential:
Phone: 561-288-5500