Provider Demographics
NPI:1013003458
Name:REGIONAL OSTEOPOROSIS CENTER OF STUART, LLC
Entity Type:Organization
Organization Name:REGIONAL OSTEOPOROSIS CENTER OF STUART, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:N
Authorized Official - Last Name:FISKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-286-9779
Mailing Address - Street 1:2081 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3347
Mailing Address - Country:US
Mailing Address - Phone:772-286-9779
Mailing Address - Fax:772-283-0287
Practice Address - Street 1:2081 SE OCEAN BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3347
Practice Address - Country:US
Practice Address - Phone:772-286-9779
Practice Address - Fax:772-283-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR36022300291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory