1548778418 NPI number — MULTISPECIALTY HEALTH NETWORK OF 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 1548778418 NPI number — MULTISPECIALTY HEALTH NETWORK OF FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULTISPECIALTY HEALTH NETWORK OF 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:
SPINE CIN OF ORLANDO, LLC
Provider Other Organization Name Type Code:
4
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:
1548778418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 WOODMONT BLVD STE 350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-386-0064
Provider Business Mailing Address Fax Number:
615-386-0067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40100 HIGHWAY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33837-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-386-0064
Provider Business Practice Location Address Fax Number:
615-386-0067
Provider Enumeration Date:
01/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HANNON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, MARKETING AND COMMUNICATIONS
Authorized Official Telephone Number:
615-386-0064

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0117X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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