Healthcare Provider Details

I. General information

NPI: 1891423836
Provider Name (Legal Business Name): CAPITAL ORTHOPAEDICS AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4362 NORTHLAKE BLVD STE 209
PALM BEACH GARDENS FL
33410-6270
US

IV. Provider business mailing address

4362 NORTHLAKE BLVD STE 209
PALM BEACH GARDENS FL
33410-6270
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-9606
  • Fax:
Mailing address:
  • Phone: 561-345-2299
  • Fax: 888-830-1589

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 Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY MORGAN
Title or Position: ADMINISTRATOR
Credential: CMPE
Phone: 561-267-1817