Provider Demographics
NPI:1386912624
Name:ORTHO FLORIDA, LLC
Entity type:Organization
Organization Name:ORTHO FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-300-1779
Mailing Address - Street 1:PO BOX 978766
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-8766
Mailing Address - Country:US
Mailing Address - Phone:561-300-1792
Mailing Address - Fax:
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-776-4707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-01
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6142960007Medicare NSC