SOUTH DADE ORTHOPAEDIC ASSOCIATES PA

Provider Demographics

• NPI: 1386687499
• Name: SOUTH DADE ORTHOPAEDIC ASSOCIATES PA
• Entity Type: Organization
• Organization Name: SOUTH DADE ORTHOPAEDIC ASSOCIATES PA
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: THEODORE
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: EVANS
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 305-274-5959
• Mailing Address - Street 1: 7867 N KENDALL DR
• Mailing Address - Street 2: SUITE 130
• Mailing Address - City: MIAMI
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33156-7735
• Mailing Address - Country: US
• Mailing Address - Phone: 305-274-5959
• Mailing Address - Fax: 305-275-0690
• Practice Address - Street 1: 7867 N KENDALL DR
• Practice Address - Street 2: SUITE 130
• Practice Address - City: MIAMI
• Practice Address - State: FL
• Practice Address - Zip Code: 33156-7735
• Practice Address - Country: US
• Practice Address - Phone: 305-274-5959
• Practice Address - Fax: 305-275-0690
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-14
• Last Update Date: 2008-04-20

Provider Licenses

State	License ID	Taxonomies
FL	ME47564	207X00000X
FL	ME36255	207X00000X
FL	ME22368	207X00000X
FL	ME96926	207X00000X
FL	PO2781	213E00000X
FL	PA3551	363A00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	DA2535	Other	RAILRAOD MEDICARE
FL	2777739800	Medicaid
	38941	Other	BCBS
	7574	Other	OWCP
	206419	Other	AVMED
	54511	Other	JMH
	CR 16002400	Other	OWCP
	7574	Other	ONE SOURCE
	=========	Other	WELL CARE
	54511	Other	JMH
	=========	Other	AETNA
	=========	Other	CIGNA
	DA2535	Other	RAILRAOD MEDICARE
FL	2777739800	Medicaid
	=========	Other	CIGNA