Healthcare Provider Details

I. General information

NPI: 1093746497
Provider Name (Legal Business Name): FLORIDA O & P SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 OLD MOULTRIE RD SUITE 110
ST AUGUSTINE FL
32084-4171
US

IV. Provider business mailing address

3636 UNIVERSITY BLVD S SUITE B10
JACKSONVILLE FL
32216-4250
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-0027
  • Fax: 904-808-9973
Mailing address:
  • Phone: 904-737-7755
  • Fax: 904-737-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR46
License Number StateFL

VIII. Authorized Official

Name: MR. MATTHEW PRIESTLY BAILEY
Title or Position: PRESIDENT
Credential: C.P.O
Phone: 904-737-7755