Basic Information
| Provider Information | |||||||||
| NPI: | 1174998629 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TFPS IV, L.L.C. | ||||||||
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| OtherOrganizationName: | FLORIDA INSTITUTE OF ORTHOPAEDIC SURGICAL SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9960 CENTRAL PARK BLVD N | ||||||||
| Address2: | STE 400 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334281759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612885500 | ||||||||
| FaxNumber: | 5614821469 | ||||||||
| Practice Location | |||||||||
| Address1: | 2307 W BROWARD BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333121417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547921010 | ||||||||
| FaxNumber: | 9547921199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2015 | ||||||||
| LastUpdateDate: | 12/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | MCCAULEY | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5612885500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TENET FLORIDA PHYSICIAN SERVICES, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207XX0004X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.