Provider Demographics
NPI:1548219926
Name:ORTHOPEDIC INNOVATORS INC
Entity Type:Organization
Organization Name:ORTHOPEDIC INNOVATORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-0159
Mailing Address - Street 1:8900 SW 117TH AVE
Mailing Address - Street 2:SUITE B-104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2175
Mailing Address - Country:US
Mailing Address - Phone:305-279-0159
Mailing Address - Fax:786-263-0179
Practice Address - Street 1:8900 SW 117TH AVE
Practice Address - Street 2:SUITE B-104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2175
Practice Address - Country:US
Practice Address - Phone:305-279-0159
Practice Address - Fax:786-263-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9887Medicare PIN