SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. (NPI# 1730500497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730500497 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. |
| Practice Address |
1658 St Vincents Way Ste 100 Middleburg FL 32068-8447 |
| Mailing Address |
6500 Bowden Rd Suite 103 Jacksonville FL 32216-8070 |
| Practice Telephone | 9046340640 |
| Practice Fax Number | 9046340203 |
| Mailing Telephone | 9046340640 |
| Mailing Fax Number | 9046340203 |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2015-12-30 |
| Authorized Official Name | GAVAN R DUFFY (PRESIDENT / CEO) |
| Authorized Official Telephone | 9046340640 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | FL | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295156941 | Southeast Orthopedic Specialists, Inc. | Specialist | 10475 Centurion Pkwy N Ste 220, Jacksonville, FL 32256-5004 | 2013-12-26 |
| 1922615830 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2020-09-24 |
| 1881179638 | Southeast Orthopedic Specialists, Inc. | Specialist | 4565 Us Highway 17 Ste 200, Fleming Island, FL 32003-4823 | 2018-09-27 |
| 1477058709 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2001 County Road 210 W Ste 200, Saint Johns, FL 32259-2063 | 2018-03-28 |
| 1114383023 | Southeast Orthopedic Specialists, Inc. | Specialist | 15255 Max Leggett Pkwy, 5th Floor, Jacksonville, FL 32218-7273 | 2016-01-07 |
| 1730500489 | Southeast Orthopedic Specialists, Inc. | Specialist | 2300 Park Ave, Suite 203, Orange Park, FL 32073-5571 | 2013-12-26 |
| 1629025820 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2627 Riverside Ave, 3rd Floor, Jacksonville, FL 32204-4712 | 2006-05-31 |
| Street Address |
1658 ST VINCENTS WAY STE 100 |
| City | MIDDLEBURG |
| State | FL |
| Zip Code | 32068-8447 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063733855 | Alexandra V Perry | Internal Medicine | 1658 St Vincents Way Ste 100, Middleburg, FL 32068-8459 | 2010-06-16 |
| 1497234769 | Justin Michael Mcginnis | Physician Assistant | 1658 St Vincents Way Ste 100, Middleburg, FL 32068 | 2018-08-08 |
| 1043518756 | Tera Daniells Maple | Nurse Practitioner | 1658 St Vincents Way Ste 100, Middleburg, FL 32068-8459 | 2011-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073084174 | Christopher Littles | Technician | 3122 Angora Bay Dr, Middleburg, FL 32068 | 2018-12-16 |
| 1730685157 | Children's Express Care Clinic | Pediatrics | 430 College Drive, Suite 100-102, Middleburg, FL 32068 | 2018-04-04 |
| 1588162762 | Lp Sw Jacksonville, LLC | Skilled Nursing Facility | 1280 Henley Road, Middleburg, FL 32068 | 2018-01-23 |
| 1396264982 | Michael Jessie Visita Roberts | Physical Therapy Assistant | 1648 St. Vincents Way, 100b, Middleburg, FL 32068 | 2017-09-14 |
| 1093239915 | Kevia Hart | In Home Supportive Care | 2718 Tina Lane, Middleburg, FL 32068 | 2017-08-02 |
| 1366899825 | Serena Burr | Midwife | 1986 Friendly Pl, Middleburg, FL 32068 | 2016-05-15 |
| 1932573672 | Jamie Dietrich | Physical Therapist | 2583-3 County Road 220, Middleburg, FL 32068 | 2015-11-18 |
| 1154791614 | Katherine Wenger | Physical Therapist | 2580-3 Country Road 220, Suite 3, Middleburg, FL 32068 | 2015-09-28 |
| 1699024240 | Amanda Copeland | Speech-Language Pathologist | 2823 Woodstone Dr., Middleburg, FL 32068 | 2012-08-29 |
| 1194089243 | Good Samaritan Home Companion Services, Inc. | In Home Supportive Care | 3689 Main Street, Middleburg, FL 32068 | 2012-07-03 |
| Find all providers in zip 32068 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699184689 | Nicole Jackson | Specialist | 3983 Thunder Heights Ln, Middleburg, FL 32068-7362 | 2014-08-05 |
| 1144569179 | Chas Group | Specialist | 2580-3 County Road 220, Middleburg, FL 32068-6532 | 2013-02-12 |
| 1316262124 | William B Wolf IIi | Specialist | 21257 Foxcroft Rd, Middleburg, VA 20117-3425 | 2010-04-05 |
| 1275547523 | Alice Faye Sellers | Specialist | 2991 Tuscarora Trl, Middleburg, FL 32068-8226 | 2006-07-29 |
| 1205247210 | Northeast Florida Endocrine and Diabetes Associates, Pa | Specialist | 1670 St Vincents Way, Middleburg, FL 32068-8447 | 2014-05-13 |
| 1740335652 | Lucianos Urgent Care | Specialist | 3360 County Road 220, Middleburg, FL 32068-4359 | 2007-01-24 |
| 1982661484 | Garry L Taylor | Specialist | 1658 St. Vincent's Way, Suite 300, Middleburg, FL 32068-8431 | 2006-04-27 |
| 1114983376 | Leon C Chow | Specialist | 1658 St Vincents Way, Suite 300, Middleburg, FL 32068-8431 | 2006-04-25 |
| 1861458663 | Omar F Dajani | Specialist | 1658 St. Vincent's Way, Suite 300, Middleburg, FL 32068-8431 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437758893 | Ursula Olazabal | Specialist | 402 N Babcock St Ste 101, Melbourne, FL 32935-7335 | 2020-10-18 |
| 1043818529 | Michele Rosenthal | Specialist | 425 Greenwich Circle, #107, Jupiter, FL 33458-4809 | 2020-10-15 |
| 1184230096 | Lauren Daisey Woodruff | Specialist | 4440 Nelson Ave, Sarasota, FL 34231-7515 | 2020-09-17 |
| 1699385823 | Suzanne Denise Moe | Specialist | 48 Nw 4th St, Homestead, FL 33030-5942 | 2020-08-03 |
| 1437768033 | Coastal Injury Clinic LLC | Specialist | 2700 Riverside Ave Ste 1, Jacksonville, FL 32205-8233 | 2020-07-29 |
| 1417566712 | Angela Berry Williams | Specialist | 5175 W Atlantic Ave Ste C, Delray Beach, FL 33484-8101 | 2020-07-23 |
| 1255957643 | Rhonda D Smith Roberts | Specialist | 2754 Sam Hardwick Blvd, Jacksonville, FL 32246-3892 | 2020-06-22 |
| 1316562911 | A School 4 Legends LLC | Specialist | 11565 Se 57th Ct, Belleview, FL 34420-4361 | 2020-06-10 |
| 1700400397 | Juda Mclaren | Specialist | 7360 Beacon Hill Loop Apt 8, Orlando, FL 32818-6431 | 2020-05-30 |
| 1811518384 | Lori Rubin | Specialist | 8181 W Broward Blvd Ste 204, Plantation, FL 33324-2049 | 2020-05-06 |
| Find all providers with the same taxonomy | ||||
| City | MIDDLEBURG |
| Zip Code | 32068 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.