Provider Demographics
NPI:1891795662
Name:ORTHOPAEDIC CENTER OF VERO BEACH P A
Entity Type:Organization
Organization Name:ORTHOPAEDIC CENTER OF VERO BEACH P A
Other - Org Name:ORTHOPAEDIC CENTER OF VERO BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WEST
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-778-2009
Mailing Address - Street 1:1285 36TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6587
Mailing Address - Country:US
Mailing Address - Phone:772-778-2009
Mailing Address - Fax:772-778-2910
Practice Address - Street 1:1285 36TH ST
Practice Address - Street 2:STE 100
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6587
Practice Address - Country:US
Practice Address - Phone:772-778-2009
Practice Address - Fax:772-778-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262371400Medicaid
FLK1079Medicare PIN
FL262371400Medicaid