Provider Demographics
NPI:1144988825
Name:HG ORTHOPEDICS
Entity type:Organization
Organization Name:HG ORTHOPEDICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-262-0852
Mailing Address - Street 1:266 NW PEACOCK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2271
Mailing Address - Country:US
Mailing Address - Phone:772-262-0852
Mailing Address - Fax:
Practice Address - Street 1:266 NW PEACOCK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2271
Practice Address - Country:US
Practice Address - Phone:772-262-0852
Practice Address - Fax:772-245-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821080946OtherTYPE 1 NPI