Provider Demographics
NPI:1073385431
Name:ON POINTE ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:ON POINTE ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AZLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-321-6551
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-0053
Mailing Address - Country:US
Mailing Address - Phone:321-321-6551
Mailing Address - Fax:321-204-7064
Practice Address - Street 1:330 N BABCOCK ST STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7324
Practice Address - Country:US
Practice Address - Phone:321-321-6551
Practice Address - Fax:321-204-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115356700Medicaid