MEDICARE: BCL ORTHO LLC

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
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1437934080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BCL ORTHO LLC

Provider Business Mailing Address
First Line	:	801 S FEDERAL HWY PH 18
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-6749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S FEDERAL HWY PH 18
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-6749
Country	:	US
Telephone Number	:	516-660-4071
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHRISITNE LEDEE
Credential	:
Telephone Number	:	516-660-4071

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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