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Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC
Active
Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET JAGUNIC (CREDENTIALING MANAGER)
(904) 634-0640
Entity
Organization
Contact information
Practice address
2627 RIVERSIDE AVE, 3RD FLOOR, JACKSONVILLE, FL 32204-4712
(904) 634-0640
(904) 634-0203
Mailing address
6500 BOWDEN RD, SUITE103, JACKSONVILLE, FL 32216-8070
(904) 634-0640
(904) 674-6155
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y90VC
BCBS
FL
Enumeration date
10/17/2013
Last updated
12/30/2015
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