Provider Demographics
NPI:1629413885
Name:ORTHO FLORIDA, LLC
Entity Type:Organization
Organization Name:ORTHO FLORIDA, LLC
Other - Org Name:MIAMI SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TOCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-410-5194
Mailing Address - Street 1:660 GLADES ROAD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BOCA
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6469
Mailing Address - Country:US
Mailing Address - Phone:305-467-5678
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5531
Practice Address - Country:US
Practice Address - Phone:305-467-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-01
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111052207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AH633AMedicare UPIN