SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. (NPI# 1629025820) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629025820 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. |
| Other Organization Name | R DAVID HEEKIN, MD, PA |
| Practice Address |
2627 Riverside Ave 3rd Floor Jacksonville FL 32204-4712 |
| Mailing Address |
6500 Bowden Rd Suite 103 Jacksonville FL 32216-8070 |
| Practice Telephone | 9046340640 |
| Practice Fax Number | 9046340203 |
| Mailing Telephone | 9046340640 |
| Mailing Fax Number | 9046340203 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2019-12-04 |
| Authorized Official Name | BRETT PUCKETT (CEO) |
| Authorized Official Telephone | 9046340640 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207XX0801X |
Orthopaedic Surgery Specialization: Orthopaedic Trauma |
Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207XS0106X |
Orthopaedic Surgery Specialization: Hand Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 174400000X | Specialist | Other Service Providers |
| Other Name | Type Code |
|---|---|
| R David Heekin, MD, PA | Former Legal Business Name - Organization |
| 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 |
| 1477058709 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2001 County Road 210 W Ste 200, Saint Johns, FL 32259-2063 | 2018-03-28 |
| 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 |
| Street Address |
2627 RIVERSIDE AVE 3RD FLOOR |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32204-4712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770575052 | Belton Craig Ray | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4712 | 2005-08-22 |
| 1215549316 | Renee E Alten | Student in an Organized Health Care Education/Training Program | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-08-19 |
| 1114538634 | Faradia Pierre | Student in an Organized Health Care Education/Training Program | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-08-10 |
| 1841817772 | Kelsey Rhae Williams | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-26 |
| 1477170488 | Lisa Michelle Alley | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-26 |
| 1104443126 | Verniecea J Harris | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-26 |
| 1508483421 | Lacey J Rokita | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-26 |
| 1497372320 | Annika Tabassum | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-26 |
| 1023635943 | Yvonne Nyakio Kamau | Family Medicine | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-26 |
| 1114542859 | Olivia Michelle Bullock | Student in an Organized Health Care Education/Training Program | 2627 Riverside Ave, Jacksonville, FL 32204-4717 | 2020-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437719853 | North Florida Surgeons, Pa | Orthopaedic Surgery | 2 Shirlciff Ways, Suite 300, Jacksonville, FL 32204 | 2019-06-18 |
| 1770043531 | Manuel Viado Rosas | Physical Therapist | Bold City Therapy and Wellness LLC, 2054 Park Street, Jacksonville, FL 32204 | 2019-03-20 |
| 1255805172 | Tracie Nickole Singh | Marriage & Family Therapist | 1125 W Beaver Street, Suite 205, Jacksonville, FL 32204 | 2019-01-14 |
| 1427548544 | Bold City Therapy and Wellness LLC | Clinic/Center | 2054 Park Street, Jacksonville, FL 32204 | 2018-05-14 |
| 1356883078 | Lcn Enterprise, LLC | Case Manager/Care Coordinator | 1225 W Beaver St Ste 106, Jacksonville, FL 32204 | 2016-11-11 |
| 1073065082 | Prosser and Prosser LLC | Non-emergency Medical Transport (VAN) | 2120 Ernest St, Jacksonville, FL 32204 | 2016-10-26 |
| 1336529817 | Nader Daoud | Internal Medicine | 1 Shircliffway, Jacksonville, FL 32204 | 2015-06-01 |
| 1194119214 | Benjamin James Dionne | Internal Medicine | 2 Shircliff Way Ste 400, Jacksonville, FL 32204 | 2015-03-26 |
| 1598187932 | Jamara Stephens | Counselor | 1225 W Beaver St Ste 205, Jacksonville, FL 32204 | 2014-01-18 |
| 1154743961 | Kathleen Jasper | Nurse Anesthetist, Certified Registered | 2165 Herschel Street, Jacksonville, FL 32204 | 2014-01-14 |
| Find all providers in zip 32204 | ||||
| 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 |
|---|---|---|---|---|
| 1437768033 | Coastal Injury Clinic LLC | Specialist | 2700 Riverside Ave Ste 1, Jacksonville, FL 32205-8233 | 2020-07-29 |
| 1255957643 | Rhonda D Smith Roberts | Specialist | 2754 Sam Hardwick Blvd, Jacksonville, FL 32246-3892 | 2020-06-22 |
| 1437620986 | Nicole Azaan | Specialist | 2301 Indian Dr Apt 29c, Jacksonville, NC 28546-5258 | 2018-12-10 |
| 1598251910 | Allionz LLC | Specialist | 2386 Dunn Ave Ste 109, Jacksonville, FL 32218-4751 | 2018-07-09 |
| 1093236531 | Leah F Friedman | Specialist | 1650 Prudential Dr Ste 102, Jacksonville, FL 32207-8148 | 2017-07-06 |
| 1609301993 | Oakleaf Injury and Pain Center LLC | Specialist | 9526 Argyle Forest Blvd, B-6, Jacksonville, FL 32222-2825 | 2017-04-25 |
| 1982070140 | Riverside Spine & Pain Physicians, LLC | Specialist | 13133 Professional Dr, Suite 200, Jacksonville, FL 32225-7122 | 2015-08-11 |
| 1235525239 | Elizabeth Wehr | Specialist | 319 1st Ave N Apt 1a, Jacksonville, FL 32250-5500 | 2015-04-07 |
| 1053705236 | Orthowilmington, Pa | Specialist | 3382 Henderson Dr, Jacksonville, NC 28546-5230 | 2015-03-25 |
| 1295156941 | Southeast Orthopedic Specialists, Inc. | Specialist | 10475 Centurion Pkwy N Ste 220, Jacksonville, FL 32256-5004 | 2013-12-26 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32204 |
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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.