NPI |
1154040640 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
PSL ORTHO SPINE CORP |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Other Organization Name |
APEX ORTHO SPINE |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Other name by which the organization provider is or has been known. |
Provider First Line Business Practice Location Address |
266 NW PEACOCK BLVD STE 204 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
PORT ST LUCIE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
FL |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
349862271 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Telephone Number |
7722620852 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
7722454235 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
8/26/2022 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
5/11/2023 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Last Name |
BEATTY |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
LAURA |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official Middle Name |
C |
The middle name of the authorized official. |
Authorized Official Title or Position |
PRACTICE MANAGER |
The middle name of the authorized official. |
Authorized Official Telephone Number |
7722620852 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
363A00000X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
207X00000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
Healthcare Provider Taxonomy Group 2 |
193200000X MULTI-SPECIALTY GROUP |
|
NPI Certification Date |
5/11/2023 |
|