SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. (NPI# 1922615830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922615830 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST ORTHOPEDIC SPECIALISTS, INC. |
| Practice Address |
2 Shircliff Way Ste 605 Jacksonville FL 32204-4762 |
| Mailing Address |
6500 Bowden Rd Ste 103 Jacksonville FL 32216-8066 |
| Practice Telephone | 9046340640 |
| Practice Fax Number | 9046340203 |
| Mailing Telephone | 9046340640 |
| Mailing Fax Number | 9046340203 |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2020-09-25 |
| Authorized Official Name | BRETT CHRISTOPHER PUCKETT (PRESIDENT) |
| Authorized Official Telephone | 9046340640 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295156941 | Southeast Orthopedic Specialists, Inc. | Specialist | 10475 Centurion Pkwy N Ste 220, Jacksonville, FL 32256-5004 | 2013-12-26 |
| 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 |
| 1730500497 | Southeast Orthopedic Specialists, Inc. | Specialist | 1658 St Vincents Way Ste 100, Middleburg, FL 32068-8447 | 2013-12-26 |
| 1629025820 | Southeast Orthopedic Specialists, Inc. | Orthopaedic Surgery | 2627 Riverside Ave, 3rd Floor, Jacksonville, FL 32204-4712 | 2006-05-31 |
| Street Address |
2 SHIRCLIFF WAY STE 605 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32204-4762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124463088 | Eric G Kim | Orthopaedic Surgery | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2013-05-06 |
| 1467071829 | Kim Orthopedic LLC | Orthopaedic Surgery | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2020-04-15 |
| 1235775438 | Jacqueline M Evans | Physician Assistant | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2019-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437719853 | North Florida Surgeons, Pa | Orthopaedic Surgery | 2 Shirlciff Ways, Suite 300, Jacksonville, FL 32204 | 2019-06-18 |
| 1770043531 | Manuel Viado Rosas | Physical Therapist | Bold City Therapy and Wellness LLC, 2054 Park Street, Jacksonville, FL 32204 | 2019-03-20 |
| 1255805172 | Tracie Nickole Singh | Marriage & Family Therapist | 1125 W Beaver Street, Suite 205, Jacksonville, FL 32204 | 2019-01-14 |
| 1427548544 | Bold City Therapy and Wellness LLC | Clinic/Center | 2054 Park Street, Jacksonville, FL 32204 | 2018-05-14 |
| 1356883078 | Lcn Enterprise, LLC | Case Manager/Care Coordinator | 1225 W Beaver St Ste 106, Jacksonville, FL 32204 | 2016-11-11 |
| 1073065082 | Prosser and Prosser LLC | Non-emergency Medical Transport (VAN) | 2120 Ernest St, Jacksonville, FL 32204 | 2016-10-26 |
| 1336529817 | Nader Daoud | Internal Medicine | 1 Shircliffway, Jacksonville, FL 32204 | 2015-06-01 |
| 1194119214 | Benjamin James Dionne | Internal Medicine | 2 Shircliff Way Ste 400, Jacksonville, FL 32204 | 2015-03-26 |
| 1598187932 | Jamara Stephens | Counselor | 1225 W Beaver St Ste 205, Jacksonville, FL 32204 | 2014-01-18 |
| 1154743961 | Kathleen Jasper | Nurse Anesthetist, Certified Registered | 2165 Herschel Street, Jacksonville, FL 32204 | 2014-01-14 |
| Find all providers in zip 32204 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609483155 | Ortholonestar, Pllc | Orthopaedic Surgery | 203 Nacogdoches St Ste 350, Jacksonville, TX 75766-2454 | 2020-09-29 |
| 1437719853 | North Florida Surgeons, Pa | Orthopaedic Surgery | 2 Shirlciff Ways, Suite 300, Jacksonville, FL 32204 | 2019-06-18 |
| 1013478403 | David William Barton | Orthopaedic Surgery | 655 W 8th St, Box C-126, Jacksonville, FL 32209 | 2019-03-27 |
| 1083093991 | John Wunn Cancian Sr. | Orthopaedic Surgery | Bumed, Centralized Credential and Privileging Directora, 554 Keily Street, Jacksonville, FL 32212 | 2015-05-26 |
| 1124463088 | Eric G Kim | Orthopaedic Surgery | 2 Shircliff Way Ste 605, Jacksonville, FL 32204-4762 | 2013-05-06 |
| 1508124439 | Conor Brendan Garry | Orthopaedic Surgery | Bureau of Medicine and Surgery, Central Credentialing, 554 Keily St, Jacksonville, FL 32212 | 2012-04-28 |
| 1386924298 | George El-bahri | Orthopaedic Surgery | 6100 Kennerly Rd Ste 101, Jacksonville, FL 32216-4376 | 2011-08-23 |
| 1659667012 | Michael C Freidl | Orthopaedic Surgery | Uf Health - North, 15255 Max Leggett Parkway - Suite 6600, Jacksonville, FL 32218 | 2011-06-23 |
| 1780902643 | John Webster Williams Jr. | Orthopaedic Surgery | 4416 Gadsden Ct, Jacksonville, FL 32207-6216 | 2010-05-17 |
| 1265604599 | Asher O Smith | Orthopaedic Surgery | 2080 Child Street Naval Hospital Jacksonville, Jacksonville, FL 32214-2538 | 2008-03-27 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32204 |
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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.