Provider Demographics
NPI:1992832554
Name:ORTHOPAEDIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-863-2153
Mailing Address - Street 1:PO BOX 740923
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0923
Mailing Address - Country:US
Mailing Address - Phone:850-863-2153
Mailing Address - Fax:850-315-9350
Practice Address - Street 1:554 TWIN CITIES BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1058
Practice Address - Country:US
Practice Address - Phone:850-862-2153
Practice Address - Fax:850-315-9350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5232980003Medicare NSC