Provider Demographics
NPI:1306834841
Name:ORTHOPAEDIC SPINE & FRACTURE CLINIC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPINE & FRACTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-296-2345
Mailing Address - Street 1:PO BOX 540249
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-0249
Mailing Address - Country:US
Mailing Address - Phone:561-296-2345
Mailing Address - Fax:561-296-2346
Practice Address - Street 1:3898 VIA POINCIANA
Practice Address - Street 2:SUITE 18
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2951
Practice Address - Country:US
Practice Address - Phone:561-296-2345
Practice Address - Fax:561-296-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5279Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER