Provider Demographics
NPI:1003026600
Name:A. GIROUARD, L.L.C.
Entity type:Organization
Organization Name:A. GIROUARD, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-530-2953
Mailing Address - Street 1:6050 SAINT JOHNS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6860
Mailing Address - Country:US
Mailing Address - Phone:386-530-2953
Mailing Address - Fax:386-312-0535
Practice Address - Street 1:6050 SAINT JOHNS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6860
Practice Address - Country:US
Practice Address - Phone:386-530-2953
Practice Address - Fax:386-312-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5649050001Medicare NSC
FLAG812Medicare PIN
FLDG5611Medicare PIN