Provider Demographics
NPI:1588348783
Name:SALINE ORTHOPEDIC GROUP P A
Entity type:Organization
Organization Name:SALINE ORTHOPEDIC GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PURIFOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-315-0984
Mailing Address - Street 1:PO BOX 161106
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1106
Mailing Address - Country:US
Mailing Address - Phone:501-315-0984
Mailing Address - Fax:501-847-1405
Practice Address - Street 1:2010 ACTIVE WAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72022-9267
Practice Address - Country:US
Practice Address - Phone:501-315-0984
Practice Address - Fax:501-847-1405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALINE ORTHOPEDIC GROUP P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty