Provider Demographics
NPI:1023539574
Name:ORTHO FLORIDA, LLC
Entity Type:Organization
Organization Name:ORTHO FLORIDA, LLC
Other - Org Name:SOUTH MIAMI WALK-IN ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-787-1128
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 1:5966 S DIXIE HWY STE 401
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5177
Practice Address - Country:US
Practice Address - Phone:786-453-2667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-05
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty