Provider Demographics
NPI:1104068915
Name:FLORIDA O&P SERVICES INC
Entity type:Organization
Organization Name:FLORIDA O&P SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-278-7025
Mailing Address - Street 1:1045 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4127
Mailing Address - Country:US
Mailing Address - Phone:904-353-8005
Mailing Address - Fax:904-353-8007
Practice Address - Street 1:1045 RIVERSIDE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4127
Practice Address - Country:US
Practice Address - Phone:904-353-8005
Practice Address - Fax:904-353-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR154335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier