Provider Demographics
NPI:1942408729
Name:EASTERN SHORE ORTHOPAEDIC CENTER, P.C.
Entity Type:Organization
Organization Name:EASTERN SHORE ORTHOPAEDIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ-FEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-4033
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1212
Mailing Address - Country:US
Mailing Address - Phone:251-928-4033
Mailing Address - Fax:251-928-4032
Practice Address - Street 1:912 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2952
Practice Address - Country:US
Practice Address - Phone:251-928-4033
Practice Address - Fax:251-928-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11349207X00000X
ALPTH3108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529400020Medicaid
AL51088164OtherBCBS
AL51094156OtherBCBS
AL529400020Medicaid
ALC75483Medicare UPIN
AL000088164Medicare PIN