Provider Demographics
NPI:1356337604
Name:FLORIDA BRACING CENTERS INC
Entity type:Organization
Organization Name:FLORIDA BRACING CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-525-6700
Mailing Address - Street 1:500 SE 17TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2547
Mailing Address - Country:US
Mailing Address - Phone:954-525-6700
Mailing Address - Fax:954-525-4330
Practice Address - Street 1:500 SE 17TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2547
Practice Address - Country:US
Practice Address - Phone:954-525-6700
Practice Address - Fax:954-525-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR141224P00000X
FL1312313332B00000X
FLORT109222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032008100Medicaid
FL032008100Medicaid