1386952554 NPI number — TOTAL SPINE CARE ASSOCIATES OF SOUTH FLORIDA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386952554 NPI number — TOTAL SPINE CARE ASSOCIATES OF SOUTH FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL SPINE CARE ASSOCIATES OF SOUTH FLORIDA, LLC
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:
6
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:
1386952554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIRCLE PINES
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55014-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-669-7173
Provider Business Mailing Address Fax Number:
651-490-7797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 NW 82ND AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-6658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-716-8348
Provider Business Practice Location Address Fax Number:
305-716-8359
Provider Enumeration Date:
09/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RAPOSO
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-716-8348

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  ME 104124 , 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)





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