Provider Demographics
NPI:1093818171
Name:ORTHOPAEDIC CENTER OF S FLORIDA
Entity Type:Organization
Organization Name:ORTHOPAEDIC CENTER OF S FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-473-6344
Mailing Address - Street 1:600 S PINE ISLAND ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-473-6344
Mailing Address - Fax:954-476-9077
Practice Address - Street 1:600 S PINE ISLAND ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-473-6344
Practice Address - Fax:954-476-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0643530001Medicare NSC
FL94489XMedicare PIN
FLE70656Medicare UPIN
FLG24477Medicare UPIN
FLD63250Medicare UPIN
FL61200YMedicare PIN
FL26342XMedicare PIN
FL14494YMedicare PIN
FL12287ZMedicare PIN
FL10417ZMedicare PIN
FL10198XMedicare PIN
FLE62244Medicare UPIN
FLE53971Medicare UPIN
FLG03815Medicare UPIN
FLE01964Medicare UPIN
FLD65251Medicare UPIN
FL31431Medicare PIN
FLF94094Medicare UPIN
FL28911ZMedicare PIN