Provider Demographics
NPI:1811199698
Name:ORTHOPEDIC & SPINE CENTER OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE CENTER OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-941-2679
Mailing Address - Street 1:150 SW 12TH AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-941-2679
Mailing Address - Fax:954-941-6169
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-941-2679
Practice Address - Fax:954-941-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1699857466OtherNPI
FLME0073142OtherMEDICAL LICENSE
FLME0073142OtherMEDICAL LICENSE
FLF95108Medicare UPIN