Healthcare Provider Details

I. General information

NPI: 1699355651
Provider Name (Legal Business Name): BEYOND THE SCOPE ORTHOPAEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HIBISCUS BLVD
MELBOURNE FL
32901-3156
US

IV. Provider business mailing address

200 E HIBISCUS BLVD
MELBOURNE FL
32901-3156
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-5550
  • Fax: 321-728-7553
Mailing address:
  • Phone: 321-361-5550
  • Fax: 321-728-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ANDREW PALSIS
Title or Position: ORTHOPAEDIC SURGEON
Credential: MD
Phone: 321-361-5550