SOUTHEAST ORTHOPEDIC SPECIALISTS, INC (NPI# 1972969756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972969756 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ORTHOPEDIC SPECIALISTS, INC |
| Practice Address |
2627 Riverside Ave Suite 300 Jacksonville FL 32204-4712 |
| Mailing Address |
Po Box 9830 Salt Lake City UT 84109-9830 |
| Practice Telephone | 7277550693 |
| Practice Fax Number | 7277550679 |
| Mailing Telephone | 7277550693 |
| Mailing Fax Number | 7277550679 |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2016-01-08 |
| Authorized Official Name | NICOLE SISKO (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 7277550693 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | ME80485 | FL | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548681109 | Southeast Orthopedic Specialists, Inc | Specialist | 232 Ponte Vedra Park Dr, Ponte Vedra Beach, FL 32082-6600 | 2013-12-30 |
| 1003244658 | Southeast Orthopedic Specialists, Inc | Physical Therapist | 2627 Riverside Ave, 3rd Floor, Jacksonville, FL 32204-4712 | 2013-10-17 |
| Street Address |
2627 RIVERSIDE AVE SUITE 300 |
| 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 | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033626122 | Dedicated Senior Medical Center of Florida, LLC | Non-Pharmacy Dispensing Site | 3059 Edgewood Avenue West, Jacksonville, FL 32209 | 2018-01-10 |
| 1346757432 | Dedicated Senior Medical Center of Florida, LLC | Non-Pharmacy Dispensing Site | 9422 Arlington Expressway, Jacksonville, FL 32225 | 2018-01-10 |
| 1306033915 | Linear Rx, Inc | Non-Pharmacy Dispensing Site | 3333 Hendricks Ave, Jacksonville, FL 32207-5301 | 2007-09-27 |
| 1932680469 | Florida Physician Specialists LLC | Non-Pharmacy Dispensing Site | 7017 A C Skinner Pkwy, Jacksonville, FL 32256-6932 | 2018-08-23 |
| 1114434206 | Dedicated Senior Medical Center of Florida, LLC | Non-Pharmacy Dispensing Site | 6841 Blanding Blvd, Jacksonville, FL 32244 | 2018-01-10 |
| 1124531082 | Springfield Clinic LLP | Non-Pharmacy Dispensing Site | 1000 W Morton Ave, Jacksonville, IL 62650-3152 | 2017-11-14 |
| 1053776468 | Se Orthopedic Specialists | Non-Pharmacy Dispensing Site | 15255 Max Leggett Pkwy, 5th Floor, Jacksonville, FL 32218-7273 | 2015-12-30 |
| 1275998908 | Se Orthopedic Specialists | Non-Pharmacy Dispensing Site | 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 | 2015-12-23 |
| 1295105310 | Podiatry Associates of Florida, Inc. | Non-Pharmacy Dispensing Site | 1914 Southside Blvd, #1, Jacksonville, FL 32216-1996 | 2015-10-01 |
| 1528450285 | Planned Parenthood of South Florida & The Treasure Coast | Non-Pharmacy Dispensing Site | 5978 Powers Ave, Jacksonville, FL 32217-2210 | 2015-03-04 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32204 |
Please comment or provide details below to improve the information on SOUTHEAST ORTHOPEDIC SPECIALISTS, INC.
| 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.