Organization
ORTHOCLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL DAVIS (PRESIDENT)
(850) 630-5402
Entity
Organization
Contact information
Practice address
2315 RUTH HENTZ AVE, PANAMA CITY, FL 32405-2260
(850) 630-5402
Mailing address
2315 RUTH HENTZ AVE, PANAMA CITY, FL 32405-2260
(850) 630-5402
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000
BCBS PROVIDER #
FL
05
—
0000000000
—
FL
Enumeration date
12/10/2014
Last updated
12/10/2014
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