NPIMap

Organization Active NPI

Southeast Orthopedic Specialists, Inc

  • Non-Pharmacy Dispensing Site
  • Jacksonville, FL
National Provider Identifier
1275998908
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
10475 Centurion Pkwy N
Suite 220
Jacksonville, FL 32256-5003
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Dec 23, 2015
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 Puckett
Title
President
Phone
(904) 634-0640

Specialties & licenses 1

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

Addresses

Primary practice location

10475 Centurion Pkwy N
Suite 220
Jacksonville, FL 32256-5003

Mailing address

10475 Centurion Pkwy N Ste 220
Jacksonville, FL 32256-5004
Phone (904) 634-0640

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": "1450828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1275998908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N STE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565004",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N",
            "address_2": "SUITE 220",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565003",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-23",
        "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.