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General NPI Number Information
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NPI Number | 1568942431
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Entity Type | Organization
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Legal Business Name | BLUE DIAMOND ORTHOPEDIC, LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 6439 MILNER BLVD STE 4
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City | ORLANDO
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State | FL
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Zip | 32809-6692
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Country | US
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Telephone | 407-613-2001
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Fax | 407-613-2010
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Provider Business Mailing Address
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Address Line | 6439 MILNER BLVD STE 4
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City | ORLANDO
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State | FL
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Zip | 32809-6692
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Country | US
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Telephone | 407-613-2001
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Fax | 407-613-2010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID HENDRICKS
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Credential | CPO
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Telephone | 407-613-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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