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Organization
ORANGE PARK ACUTE TRAUMA,LLC
Active
Organization
ORANGE PARK ACUTE TRAUMA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KONDAS (OFFICER)
(317) 614-9871
Entity
Organization
Contact information
Practice address
2140 KINGSLEY AVE, SUITE 14, ORANGE PARK, FL 32073-5180
(972) 265-0370
(214) 712-2444
Mailing address
5565 CENTERVIEW DR STE 107, RALEIGH, NC 27606-3563
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0127X
Trauma Surgery Physician
Primary
—
NULL
2086S0127X
Trauma Surgery Physician
Primary
—
—
Other
Enumeration date
02/13/2013
Last updated
04/20/2021
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