Healthcare Provider Details

I. General information

NPI: 1710992599
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOC OF ST AUGUSTINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ORTHOPAEDIC PLACE
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

ONE ORTHOPAEDIC PLACE
ST AUGUSTINE FL
32086-4202
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax: 904-825-2490
Mailing address:
  • Phone: 904-825-0540
  • Fax: 904-825-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALBERT G VOLK
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 904-825-0540