Provider Demographics
NPI:1053477687
Name:KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:KENNEDY WHITE & RIGGS ORTHOPEDIC ASSOCIATES
Other - Org Name:KENNEDY-WHITE ORTHOPAEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:941-365-0655
Mailing Address - Street 1:6050 CATTLERIDGE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6014
Mailing Address - Country:US
Mailing Address - Phone:941-365-0655
Mailing Address - Fax:941-366-8043
Practice Address - Street 1:6050 CATTLERIDGE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6014
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:941-366-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4961480001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4961480001Medicare NSC