NPIMap

Organization Active NPI

Southeast Orthopedic Specialists, Inc

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1003244658
Registry record updated Dec 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC
Practice address
2627 Riverside Ave
3Rd Floor
Jacksonville, FL 32204-4712
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Oct 17, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janet Jagunic
Title
Credentialing Manager
Phone
(904) 634-0640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

2627 Riverside Ave
3Rd Floor
Jacksonville, FL 32204-4712

Mailing address

6500 Bowden Rd
Suite103
Jacksonville, FL 32216-8070
Phone (904) 634-0640

Other identifiers 1

IdentifierTypeStateIssuer
Y90VCOtherFLBCBS

National Provider Directory

National Provider Directory
Tax ID family
Southeast Orthopedic Specialists Inc38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451433600000",
    "number": "1003244658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BOWDEN RD",
            "address_2": "SUITE103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168070",
            "telephone_number": "904-634-0640",
            "fax_number": "904-674-6155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "address_2": "3RD FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-17",
        "last_updated": "2015-12-30",
        "status": "A",
        "authorized_official_last_name": "JAGUNIC",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "904-634-0640"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y90VC",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.