Provider Demographics
NPI:1366461592
Name:AMELIA ISLAND ORTHPEDICS
Entity type:Organization
Organization Name:AMELIA ISLAND ORTHPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-261-8787
Mailing Address - Street 1:1250 S 18TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1902
Mailing Address - Country:US
Mailing Address - Phone:904-261-8787
Mailing Address - Fax:904-261-9353
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-261-8787
Practice Address - Fax:904-261-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66525207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCN5855OtherRAILROAD MEDICARE
FL200031351OtherRAILROAD MEDICARE
FL253374000Medicaid
FL0974040002Medicare NSC
FLCN5855OtherRAILROAD MEDICARE
FL21596Medicare PIN