Provider Demographics
NPI:1609032309
Name:ADVANCED SHOULDER ORTHOPAEDICS
Entity Type:Organization
Organization Name:ADVANCED SHOULDER ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-622-6111
Mailing Address - Street 1:600 UNIVERSITY BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2778
Mailing Address - Country:US
Mailing Address - Phone:561-622-6111
Mailing Address - Fax:
Practice Address - Street 1:5405 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE # 304
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4543
Practice Address - Country:US
Practice Address - Phone:561-255-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty