Provider Demographics
NPI:1750818548
Name:ORTHOPEDIC CENTER OF PALM BEACH COUNTY
Entity Type:Organization
Organization Name:ORTHOPEDIC CENTER OF PALM BEACH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORNBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-967-6500
Mailing Address - Street 1:180 JFK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6641
Mailing Address - Country:US
Mailing Address - Phone:561-967-6500
Mailing Address - Fax:561-423-4687
Practice Address - Street 1:11195 S JOG RD
Practice Address - Street 2:UNIT 5
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1829
Practice Address - Country:US
Practice Address - Phone:561-314-7200
Practice Address - Fax:561-314-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036093700Medicaid
FL036093700Medicaid