Provider Demographics
NPI:1093746497
Name:FLORIDA O & P SERVICES INC
Entity Type:Organization
Organization Name:FLORIDA O & P SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PRIESTLY
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:904-737-7755
Mailing Address - Street 1:3636 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE B10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4250
Mailing Address - Country:US
Mailing Address - Phone:904-737-7755
Mailing Address - Fax:904-737-7962
Practice Address - Street 1:1797 OLD MOULTRIE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4171
Practice Address - Country:US
Practice Address - Phone:904-826-0027
Practice Address - Fax:904-808-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR46335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1197200002Medicare ID - Type UnspecifiedMEDICARE NUMBER