MEDICARE: AVANTA ORTHOPEDICS 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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518382720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVANTA ORTHOPEDICS INC.

Provider Business Mailing Address
First Line	:	7295-1 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155
Country	:	US
Telephone Number	:	305-262-1721
Fax Number	:	305-262-1723

Provider Business Practice Location Address
First Line	:	7295-1 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155
Country	:	US
Telephone Number	:	305-262-1721
Fax Number	:	305-262-1723

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS AMANDA MARTINEZ
Credential	:
Telephone Number	:	305-262-1721

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	07/28/2015

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