Southeast Orthopedic Specialists, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

Practice address

2001 County Road 210 W Ste 200
Saint Johns, FL 32259-2063

Phone

(904) 634-0640

Fax

(904) 634-0203

NPI assigned

Mar 28, 2018

Organization subpart

No

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

Authorized official

Name

Brett Puckett

Title

VP

Phone

(904) 634-0640

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1477058709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 SOUTHPOINT PKWY STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168203",
            "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": "2001 COUNTY ROAD 210 W STE 200",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322592063",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "904-634-0640"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K4080",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southeast Orthopedic Specialists, Inc
• Southeast Orthopedic Specialists, LLC
• Southeast Orthopedic Specialists, LLC
• Southeast Orthopedic Specialists, LLC
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• Spame
• Connor Spangenberg
• Speech With Nicole LLC

• Specialist in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.