Provider Demographics
NPI:1932249257
Name:ORTHOPAEDIC SPECIALISTS PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-799-2224
Mailing Address - Street 1:699 W COCOA BEACH CSWY
Mailing Address - Street 2:STE 405
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3577
Mailing Address - Country:US
Mailing Address - Phone:321-799-2224
Mailing Address - Fax:321-799-2144
Practice Address - Street 1:699 W COCOA BEACH CSWY
Practice Address - Street 2:STE 405
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3577
Practice Address - Country:US
Practice Address - Phone:321-799-2224
Practice Address - Fax:321-799-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12026207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200026933OtherRAILROAD MEDICARE ID
FL0546190001OtherDMERC ID NUMBER
0546190001Medicare NSC
FL200026933OtherRAILROAD MEDICARE ID
200026933Medicare PIN
FL05203Medicare ID - Type Unspecified