Provider Demographics
NPI:1659998904
Name:ORTHOPAEDIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-863-2153
Mailing Address - Street 1:PO BOX 740923
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0923
Mailing Address - Country:US
Mailing Address - Phone:850-860-2153
Mailing Address - Fax:850-315-9350
Practice Address - Street 1:5300 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5235
Practice Address - Country:US
Practice Address - Phone:850-863-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty