Provider Demographics
NPI:1962598623
Name:BAHRI ORTHOPEDICS & SPORTS MEDICINE CLINIC, P.L.
Entity type:Organization
Organization Name:BAHRI ORTHOPEDICS & SPORTS MEDICINE CLINIC, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL BAHRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-739-0050
Mailing Address - Street 1:6100 KENNERLY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-739-0050
Mailing Address - Fax:
Practice Address - Street 1:6100 KENNERLY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-739-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72275Medicare ID - Type Unspecified