Provider Demographics
NPI:1952848327
Name:ORTHOPEDIC & SPINE SPECIALISTS OF THE PALM BEACHES LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE SPECIALISTS OF THE PALM BEACHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-546-9591
Mailing Address - Street 1:8929 SE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5312
Mailing Address - Country:US
Mailing Address - Phone:772-546-9591
Mailing Address - Fax:
Practice Address - Street 1:7749 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2536
Practice Address - Country:US
Practice Address - Phone:561-434-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty