Provider Demographics
NPI:1477521953
Name:COMMUNITY ORTHOPEDICS & CENTER FOR JOINT REPLACEMENT, INC
Entity Type:Organization
Organization Name:COMMUNITY ORTHOPEDICS & CENTER FOR JOINT REPLACEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-724-3400
Mailing Address - Street 1:7225 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-724-3400
Mailing Address - Fax:954-724-9451
Practice Address - Street 1:7225 N UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-724-3400
Practice Address - Fax:954-724-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254166100Medicaid
FL21550Medicare PIN
FL254166100Medicaid