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NPI Code Detail

MEDICARE: SOUTH BEACH ORTHOTICS & PROSTHETICS, INC

MEDICARE: SOUTH BEACH ORTHOTICS & PROSTHETICS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1326302928
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH BEACH ORTHOTICS & PROSTHETICS, INC
Provider Business Mailing Address
First Line : 3350 NW 2ND AVENUE
Second Line : SUITE B-18
City : BOCA RATON
State : FL
Zip : 33431
Country : US
Telephone Number : 561-394-4200
Fax Number : 561-394-4422
Provider Business Practice Location Address
First Line : 4751 W 4TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-3938
Country : US
Telephone Number : 786-577-0283
Fax Number : 305-675-3706
Authorized Official
Title or Position : OWNER / PRESIDENT
Name : MR. MARK SELLECK
Credential :
Telephone Number : 561-394-4200
Provider Enumeration Date : 06/28/2012
Last Update Date : 03/21/2019

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Directions to “SOUTH BEACH ORTHOTICS & PROSTHETICS, INC ” Practice Location

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