Provider Demographics
NPI:1841757580
Name:MELI ORTHOPEDIC CENTERS OF EXCELLENCE, LLC
Entity Type:Organization
Organization Name:MELI ORTHOPEDIC CENTERS OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:GERNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-451-3008
Mailing Address - Street 1:PO BOX 162743
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2743
Mailing Address - Country:US
Mailing Address - Phone:954-580-4080
Mailing Address - Fax:954-530-5069
Practice Address - Street 1:201 NW 82ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1853
Practice Address - Country:US
Practice Address - Phone:954-771-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL169408500OtherDEPARTMENT OF LABOR
FL051855700Medicaid