Provider Demographics
NPI: | 1497150239 |
---|---|
Name: | TOTAL MD ORTHOPEDICS & NEUROSURGERY |
Entity Type: | Organization |
Organization Name: | TOTAL MD ORTHOPEDICS & NEUROSURGERY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DONNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MARK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 561-967-8888 |
Mailing Address - Street 1: | 6742 FOREST HILL BLVD |
Mailing Address - Street 2: | SUITE 291 |
Mailing Address - City: | GREENACRES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33413-3321 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 561-967-8888 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7000 W CAMINO REAL |
Practice Address - Street 2: | SUITE 210 |
Practice Address - City: | BOCA RATON |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33433-5532 |
Practice Address - Country: | US |
Practice Address - Phone: | 561-967-8888 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-10-22 |
Last Update Date: | 2014-10-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | CH5626 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty |