Provider Demographics
NPI:1821113192
Name:ORTHO FLORIDA, LLC
Entity Type:Organization
Organization Name:ORTHO FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SKYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-300-1779
Mailing Address - Street 1:PO BOX 978766
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-8766
Mailing Address - Country:US
Mailing Address - Phone:561-300-1792
Mailing Address - Fax:561-300-1879
Practice Address - Street 1:660 GLADES ROAD
Practice Address - Street 2:SUITE 460
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6469
Practice Address - Country:US
Practice Address - Phone:561-300-1779
Practice Address - Fax:561-300-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6142960006Medicare NSC
FL6142960005Medicare NSC
FL6142960001Medicare NSC
FL6142960008Medicare NSC
FL6142960007Medicare NSC