Provider Demographics
NPI:1558465948
Name:ORTHO HIP CHICKS, LLC
Entity Type:Organization
Organization Name:ORTHO HIP CHICKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-699-5555
Mailing Address - Street 1:1061 MAITLAND CNT COMMONS BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7435
Mailing Address - Country:US
Mailing Address - Phone:407-699-5555
Mailing Address - Fax:407-210-8012
Practice Address - Street 1:1061 MAITLAND CNT COMMONS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7435
Practice Address - Country:US
Practice Address - Phone:407-699-5555
Practice Address - Fax:407-210-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5924570001Medicare NSC