Provider Demographics
NPI:1437601598
Name:OPTIM ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:OPTIM ORTHOPEDICS LLC
Other - Org Name:OPTIM ORTHOPEDICS HHI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-5300
Mailing Address - Street 1:95 SEA ISLAND PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1499
Mailing Address - Country:US
Mailing Address - Phone:843-705-9401
Mailing Address - Fax:843-705-8202
Practice Address - Street 1:460 MALL BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4801
Practice Address - Country:US
Practice Address - Phone:912-644-1626
Practice Address - Fax:912-644-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE488Medicare PIN
GA202G705424Medicare Oscar/Certification