=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811372097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTHROS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2015
-----------------------------------------------------
Last Update Date | 11/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12535 SOUTH DIXIE HIGHWAY
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-678-0601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12535 SOUTH DIXIE HIGHWAY
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-678-0601
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER LLC
-----------------------------------------------------
Name | MR. EDUARDO J LUIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-678-0601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | ME-88609
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------