1225433741 NPI number — LAKE NONA SPINE CENTER, INC.

Table of content: DR. CHING PANG TSAI DDS (NPI 1053425579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225433741 NPI number — LAKE NONA SPINE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE NONA SPINE CENTER, INC.
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:
1225433741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10979 SAVANNAH LANDING CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32832-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-299-5266
Provider Business Mailing Address Fax Number:
407-403-6550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10979 SAVANNAH LANDING CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32832-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-299-5266
Provider Business Practice Location Address Fax Number:
407-403-6550
Provider Enumeration Date:
10/27/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VANN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
PCEO
Authorized Official Telephone Number:
321-299-5266

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH10812 , 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)