NPIMap

Organization Active NPI

Southeast Orthopedic Specialists, Inc

  • Non-Pharmacy Dispensing Site
  • Jacksonville, FL
National Provider Identifier
1053776468
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME80485 Issued in FL
Legal business name
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC
Practice address
15255 Max Leggett Pkwy
5TH Floor
Jacksonville, FL 32218-7273
Phone
(727) 755-0693
Fax
(727) 755-0679
NPI assigned
Dec 30, 2015
Last updated
Sep 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
Brett PuckettNPI 1831150960
Title
President
Phone
(904) 634-0640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ME80485 FL Primary

Addresses

Primary practice location

15255 Max Leggett Pkwy
5TH Floor
Jacksonville, FL 32218-7273

Mailing address

PO Box 9830
Salt Lake City, UT 84109-9830
Phone (727) 755-0693

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

Locations

15255 Max Leggett Pkwy
Fl 5
Jacksonville, FL 32218

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1053776468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9830",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841099830",
            "telephone_number": "727-755-0693",
            "fax_number": "727-755-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15255 MAX LEGGETT PKWY",
            "address_2": "5TH FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187273",
            "telephone_number": "727-755-0693",
            "fax_number": "727-755-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-30",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-634-0640"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME80485",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Sep 29, 2022; 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.