Provider Demographics
NPI:1568883536
Name:OSTEOPATHIC CENTER, LLC
Entity Type:Organization
Organization Name:OSTEOPATHIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-367-1176
Mailing Address - Street 1:3915 BISCAYNE BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3737
Mailing Address - Country:US
Mailing Address - Phone:305-367-1176
Mailing Address - Fax:877-391-0039
Practice Address - Street 1:3915 BISCAYNE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3737
Practice Address - Country:US
Practice Address - Phone:305-367-1176
Practice Address - Fax:877-391-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10979207QS0010X
FL1037261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0054LOtherBCBS