Eastern Shores Orthopedic Brace Inc

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

ORT47 Issued in FL

Legal business name

EASTERN SHORES ORTHOPEDIC BRACE INC

Practice address

533 N Nova Road
Suite 104
Ormond Beach, FL 32174

Phone

(386) 427-5649

Fax

(386) 427-9018

NPI assigned

Oct 5, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mary M McDade, CO

Title

Owner

Phone

(386) 427-5649

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114013281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 N NOVA ROAD",
            "address_2": "SUITE 104A",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "32174",
            "telephone_number": "386-427-5649",
            "fax_number": "386-427-9018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 N NOVA ROAD",
            "address_2": "SUITE 104",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "32174",
            "telephone_number": "386-427-5649",
            "fax_number": "386-427-9018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORES ORTHOPEDIC BRACE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDADE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-427-5649",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CO"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthotist",
            "state": "FL",
            "license": "ORT47",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M2556",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.