Provider Demographics
NPI:1114079738
Name:ORTHOPEDIC CENTER OF PALM BEACH COUNTY, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC CENTER OF PALM BEACH COUNTY, LLC
Other - Org Name:SPORTS AND ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-967-6500
Mailing Address - Street 1:180 JFK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6641
Mailing Address - Country:US
Mailing Address - Phone:561-967-6500
Mailing Address - Fax:561-472-0467
Practice Address - Street 1:180 JFK DR
Practice Address - Street 2:STE 100
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6641
Practice Address - Country:US
Practice Address - Phone:561-967-6500
Practice Address - Fax:561-472-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0360093700Medicaid
FL00840Medicare PIN