Organization
EASTERN SHORES ORTHOPEDIC BRACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY M MCDADE CO (OWNER)
(386) 427-5649
Entity
Organization
Contact information
Practice address
533 N NOVA ROAD, SUITE 104, ORMOND BEACH, FL 32174
(386) 427-5649
(386) 427-9018
Mailing address
533 N NOVA ROAD, SUITE 104A, ORMOND BEACH, FL 32174
(386) 427-5649
(386) 427-9018
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
ORT47
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M2556
BCBS
—
Enumeration date
10/05/2006
Last updated
08/22/2020
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