Provider Demographics
NPI:1902862808
Name:ATLANTIS ORTHOPAEDICS, P.A.
Entity Type:Organization
Organization Name:ATLANTIS ORTHOPAEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-967-4400
Mailing Address - Street 1:130 JFK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1141
Mailing Address - Country:US
Mailing Address - Phone:561-967-4400
Mailing Address - Fax:
Practice Address - Street 1:130 JFK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-967-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372154000Medicaid
FL58711Medicare ID - Type UnspecifiedHOWARD D ROUTMAN MEDICARE
FL372154000Medicaid
FLG43200Medicare UPIN
FL0415890001Medicare NSC
FL97657Medicare ID - Type UnspecifiedGROUP MEDICARE ID #
FL50805Medicare ID - Type UnspecifiedJEFFREY S PENNER MEDICARE
FLG81770Medicare UPIN