Provider Demographics
NPI:1801070081
Name:GOLDEN ORTHOPAEDIC KNEE AND SPORTS MEDICINE CENTER
Entity type:Organization
Organization Name:GOLDEN ORTHOPAEDIC KNEE AND SPORTS MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-637-4200
Mailing Address - Street 1:13590 JOG RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-637-4200
Mailing Address - Fax:561-637-3222
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:SUITE 7
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-637-4200
Practice Address - Fax:561-637-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4664332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22131Medicare UPIN