Provider Demographics
NPI:1770020919
Name:ORTHOPEDIC ASSOCIATES OF ST AUGUSTINE PA
Entity Type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF ST AUGUSTINE PA
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF ST. AUGUSTINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:1 ORTHOPAEDIC PL
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 1:3055 COUNTY ROAD 210 W
Practice Address - Street 2:UNIT 110
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7000
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:2017-01-26
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty