SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. (NPI# 1477058709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477058709 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. |
| Practice Address |
2001 County Road 210 W Ste 200 Saint Johns FL 32259-2063 |
| Mailing Address |
6500 Bowden Rd Ste 103 Jacksonville FL 32216-8066 |
| Practice Telephone | 9046340640 |
| Practice Fax Number | 9046340203 |
| Mailing Telephone | 9046340640 |
| Mailing Fax Number | 9046340203 |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-09-27 |
| Authorized Official Name | JANET N JAGUNIC (CREDENTIALING) |
| Authorized Official Telephone | 9046340640 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | MEDICARE | K4080 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295156941 | Southeast Orthopedic Specialists, Inc. | Specialist | 10475 Centurion Pkwy N Ste 220, Jacksonville, FL 32256-5004 | 2013-12-26 |
| 1922615830 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2020-09-24 |
| 1881179638 | Southeast Orthopedic Specialists, Inc. | Specialist | 4565 Us Highway 17 Ste 200, Fleming Island, FL 32003-4823 | 2018-09-27 |
| 1114383023 | Southeast Orthopedic Specialists, Inc. | Specialist | 15255 Max Leggett Pkwy, 5th Floor, Jacksonville, FL 32218-7273 | 2016-01-07 |
| 1730500489 | Southeast Orthopedic Specialists, Inc. | Specialist | 2300 Park Ave, Suite 203, Orange Park, FL 32073-5571 | 2013-12-26 |
| 1730500497 | Southeast Orthopedic Specialists, Inc. | Specialist | 1658 St Vincents Way Ste 100, Middleburg, FL 32068-8447 | 2013-12-26 |
| 1629025820 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2627 Riverside Ave, 3rd Floor, Jacksonville, FL 32204-4712 | 2006-05-31 |
| Street Address |
2001 COUNTY ROAD 210 W STE 200 |
| City | SAINT JOHNS |
| State | FL |
| Zip Code | 32259-2063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306994736 | Kathleen Elizabeth Kafantaris | Social Worker | 2001 County Road 210 W Ste 200, Saint Johns, FL 32259 | 2007-01-08 |
| 1740520741 | Paul Busse | Student in an Organized Health Care Education/Training Program | 2001 County Road 210 W Ste 200, Saint Johns, FL 32259 | 2013-02-27 |
| 1134458862 | Allison Michelle Wood | Nurse Practitioner | 2001 County Road 210 W Ste 200, Saint Johns, FL 32259-2063 | 2009-12-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659904571 | Ayla Rose Yarbrough | Chiropractor | 1620 County Road 210, St. Johns County, FL 32259 | 2020-02-19 |
| 1831731009 | Andrew Dacunha, Dmd, Pa | Dentist | 71 Doctors Village Drive, Suite 303, Saint Johns, FL 32259 | 2019-10-09 |
| 1801446257 | Mary Alice Taylor | Counselor | 213 Trapper Trace Ct., St. Johns, FL 32259 | 2019-09-18 |
| 1609425826 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 155 Bartram Park Drive, Suite 100, St. Johns, FL 32259 | 2019-09-10 |
| 1518438936 | Yazji Pediatric Care | Pediatrics | 4125 Race Track Rd, Suite Number 104, Saint Johns, FL 32259 | 2018-12-11 |
| 1003328022 | Abundant Life Health Center LLC | Chiropractor | 254 Everest Lane, St. Johns, FL 32259 | 2017-10-31 |
| 1356863732 | Jennifer Eberhard | Nurse Practitioner | 335 Oxford Estates Way, Saint Johns, FL 32259 | 2017-07-07 |
| 1366986861 | Taylor Leard | Physician Assistant | 2001 County Rd 210, Suite 101, St. Johns, FL 32259 | 2016-12-19 |
| 1043760390 | Comfortable Care Dental Health Professionals, Pa | Dentist | 2532 Race Track Rd, Saint Johns, FL 32259 | 2016-10-11 |
| 1598114233 | Bright Smiles Pediatric Dentistry, Pllc | Dentist | 196 Everest Ln Unit 1, Saint Johns, FL 32259 | 2016-06-03 |
| Find all providers in zip 32259 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255799896 | Mental South Wellness Pa | Specialist | 125 Edgewater Branch Dr, Saint Johns, FL 32259-4417 | 2016-02-09 |
| 1902124522 | Julington Creek Pediatrics | Specialist | 774 State Road 13, Suite 6, Saint Johns, FL 32259-3857 | 2010-05-06 |
| 1336465780 | Dennis Stone, M.d., P.a. | Specialist | 3408 State Road 13, Saint Johns, FL 32259-9270 | 2010-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437758893 | Ursula Olazabal | Specialist | 402 N Babcock St Ste 101, Melbourne, FL 32935-7335 | 2020-10-18 |
| 1043818529 | Michele Rosenthal | Specialist | 425 Greenwich Circle, #107, Jupiter, FL 33458-4809 | 2020-10-15 |
| 1184230096 | Lauren Daisey Woodruff | Specialist | 4440 Nelson Ave, Sarasota, FL 34231-7515 | 2020-09-17 |
| 1699385823 | Suzanne Denise Moe | Specialist | 48 Nw 4th St, Homestead, FL 33030-5942 | 2020-08-03 |
| 1437768033 | Coastal Injury Clinic LLC | Specialist | 2700 Riverside Ave Ste 1, Jacksonville, FL 32205-8233 | 2020-07-29 |
| 1417566712 | Angela Berry Williams | Specialist | 5175 W Atlantic Ave Ste C, Delray Beach, FL 33484-8101 | 2020-07-23 |
| 1255957643 | Rhonda D Smith Roberts | Specialist | 2754 Sam Hardwick Blvd, Jacksonville, FL 32246-3892 | 2020-06-22 |
| 1316562911 | A School 4 Legends LLC | Specialist | 11565 Se 57th Ct, Belleview, FL 34420-4361 | 2020-06-10 |
| 1700400397 | Juda Mclaren | Specialist | 7360 Beacon Hill Loop Apt 8, Orlando, FL 32818-6431 | 2020-05-30 |
| 1811518384 | Lori Rubin | Specialist | 8181 W Broward Blvd Ste 204, Plantation, FL 33324-2049 | 2020-05-06 |
| Find all providers with the same taxonomy | ||||
| City | SAINT JOHNS |
| Zip Code | 32259 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.