1164707782 NPI number — SPINE & ORTHOPEDIC CENTER, P.A.

Table of content: (NPI 1164707782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164707782 NPI number — SPINE & ORTHOPEDIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE & ORTHOPEDIC CENTER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164707782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33603-3338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-224-9222
Provider Business Mailing Address Fax Number:
813-224-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33603-3338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-224-9222
Provider Business Practice Location Address Fax Number:
813-224-9224
Provider Enumeration Date:
10/14/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOSKOVITZ
Authorized Official First Name:
GARY
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
813-224-9222

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  ME0061357 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)