Provider Demographics
NPI:1558677351
Name:NORTH FLORIDA AMPUTATION PREVENTION CENTER, LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA AMPUTATION PREVENTION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORG
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-375-2070
Mailing Address - Street 1:2140 KINGSLEY AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-375-2070
Mailing Address - Fax:904-375-2075
Practice Address - Street 1:2140 KINGSLEY AVE STE 9
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-375-2070
Practice Address - Fax:904-375-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty