Provider Demographics
NPI:1033255641
Name:ORTHOPAEDIC & SPORTS MEDICINE CENTER OF MIAMI PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPORTS MEDICINE CENTER OF MIAMI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-661-7601
Mailing Address - Street 1:PO BOX 430430
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0430
Mailing Address - Country:US
Mailing Address - Phone:305-661-7601
Mailing Address - Fax:305-661-0154
Practice Address - Street 1:6701 SUNSET DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4529
Practice Address - Country:US
Practice Address - Phone:305-661-7601
Practice Address - Fax:305-661-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58988332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL159502800OtherUS DEPARTMENT OF LABOR
FL7890258OtherAETNA
FL209485OtherAVMED
FL2316780OtherUNITED HEALTHCARE
1024417OtherOTHER ID NUMBER-COMMERCIAL NUMBER
FL1033255641OtherCIGNA
FL000623OtherNEIGHBORHOOD HEALTH PLAN
FL39759OtherBLUE SHIELD
FL39759OtherBLUE SHIELD