Provider Demographics
NPI:1578676516
Name:ATLANTIC ORTHOPEDIC ASSOC PA
Entity Type:Organization
Organization Name:ATLANTIC ORTHOPEDIC ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-223-4965
Mailing Address - Street 1:3066 SW MARTIN DOWNS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2683
Mailing Address - Country:US
Mailing Address - Phone:772-223-4965
Mailing Address - Fax:772-781-2782
Practice Address - Street 1:3066 SW MARTIN DOWNS BLVD STE B
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2683
Practice Address - Country:US
Practice Address - Phone:772-223-4965
Practice Address - Fax:772-781-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty