Provider Demographics
NPI:1710992599
Name:ORTHOPAEDIC ASSOC OF ST AUGUSTINE PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOC OF ST AUGUSTINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-825-0540
Mailing Address - Street 1:ONE ORTHOPAEDIC PLACE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4202
Mailing Address - Country:US
Mailing Address - Phone:904-825-0540
Mailing Address - Fax:904-825-2490
Practice Address - Street 1:ONE ORTHOPAEDIC PLACE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4202
Practice Address - Country:US
Practice Address - Phone:904-825-0540
Practice Address - Fax:904-825-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174540001OtherDMERC
FLK0605Medicare ID - Type Unspecified
FL1174540001Medicare NSC