NPIMap

Organization Active NPI

SE Orthopedic Specialists

  • Non-Pharmacy Dispensing Site
  • Orange Park, FL
National Provider Identifier
1902261316
Registry record updated Dec 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME80485 Issued in FL
Legal business name
SE ORTHOPEDIC SPECIALISTS
Practice address
2300 Park Ave
Suite 203
Orange Park, FL 32073-5571
Phone
(727) 755-0693
Fax
(727) 755-0679
NPI assigned
Dec 30, 2015
Last updated
Dec 30, 2015By the provider in NPPES
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
Nicole Sisko
Title
Credentialing Specialist
Phone
(727) 755-0693

Specialties & licenses 1

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

Addresses

Primary practice location

2300 Park Ave
Suite 203
Orange Park, FL 32073-5571

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
R David Heekin MD PA38 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

2300 Park Ave
Ste 203
Orange Park, FL 32073
Phone (904) 278-0016

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": "1451433600000",
    "number": "1902261316",
    "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": "2300 PARK AVE",
            "address_2": "SUITE 203",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735571",
            "telephone_number": "727-755-0693",
            "fax_number": "727-755-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SE ORTHOPEDIC SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-30",
        "last_updated": "2015-12-30",
        "status": "A",
        "authorized_official_last_name": "SISKO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "727-755-0693"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME80485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, 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.