Basic Information
| Provider Information | |||||||||
| NPI: | 1184292575 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHO FLORIDA, LLC | ||||||||
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| OtherOrganizationName: | TYRANCE ORTHOPEDICS & SPORTS MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 433 PLAZA REAL STE 275 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334323999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613001792 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6290 LINTON BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618980303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | WEICHT | ||||||||
| AuthorizedOfficialFirstName: | ADRIANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5613001792 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORTHO FLORIDA, LLC | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.