Basic Information
| Provider Information | |||||||||
| NPI: | 1568581502 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MELI ORTHOPEDIC CENTERS OF EXCELLENCE,LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 162743 | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327162743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545804084 | ||||||||
| FaxNumber: | 9545305096 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 NE 20TH TER STE 303 | ||||||||
| Address2: | |||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547718177 | ||||||||
| FaxNumber: | 9547713629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | FENELON | ||||||||
| AuthorizedOfficialFirstName: | BRIGIDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9544513010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME0057725 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 051855700 | 05 | FL | MEDICAID |