Provider Demographics
NPI:1063485282
Name:ANDREWS ORTHOPAEDIC & SPORTS MEDICINE CENTER
Entity Type:Organization
Organization Name:ANDREWS ORTHOPAEDIC & SPORTS MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-916-3700
Mailing Address - Street 1:1118 GULF BREEZE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7800
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:
Practice Address - Street 1:1118 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7800
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207X00000X261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH89844Medicare UPIN
FL50279ZMedicare ID - Type Unspecified
AL51553980Medicare ID - Type Unspecified