Healthcare Provider Details

I. General information

NPI: 1174705644
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES USA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N PINE ISLAND RD SUITE 200
PLANTATION FL
33324-1849
US

IV. Provider business mailing address

350 N PINE ISLAND RD SUITE 200
PLANTATION FL
33324-1849
US

V. Phone/Fax

Practice location:
  • Phone: 954-476-8800
  • Fax: 954-476-1362
Mailing address:
  • Phone: 954-476-8800
  • Fax: 954-746-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME71406
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VIDYA DORAISWAMY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 954-680-2108