Provider Demographics
NPI:1508147240
Name:WELLINGTON ORTHOPEDIC INSTITUTE
Entity Type:Organization
Organization Name:WELLINGTON ORTHOPEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORNBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-967-6500
Mailing Address - Street 1:4801 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4746
Mailing Address - Country:US
Mailing Address - Phone:561-967-6500
Mailing Address - Fax:561-472-0467
Practice Address - Street 1:4801 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4746
Practice Address - Country:US
Practice Address - Phone:561-967-6500
Practice Address - Fax:561-472-0467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC CENTER OF PALM BEACH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036093700Medicaid
FL036093700Medicaid