Provider Demographics
NPI:1639246234
Name:FORT PIERCE ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:FORT PIERCE ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-523-2117
Mailing Address - Street 1:1801 S 23RD ST
Mailing Address - Street 2:SUITES 7 AND 8
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4830
Mailing Address - Country:US
Mailing Address - Phone:772-465-4651
Mailing Address - Fax:
Practice Address - Street 1:1801 S 23RD ST
Practice Address - Street 2:SUITES 7 AND 8
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4830
Practice Address - Country:US
Practice Address - Phone:772-465-4651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB110Medicare PIN