1902164072 NPI number — TARPON SPINE CENTER AND MEDICAL CENTER, 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 1902164072 NPI number — TARPON SPINE CENTER AND MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARPON SPINE CENTER AND MEDICAL CENTER, 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:
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:
1902164072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1244 S PINELLAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARPON SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34689-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-937-2086
Provider Business Mailing Address Fax Number:
727-939-2554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1244 S PINELLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARPON SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-937-2086
Provider Business Practice Location Address Fax Number:
727-939-2554
Provider Enumeration Date:
04/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MARCELL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTIC PHYSICIAN
Authorized Official Telephone Number:
727-937-2086

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  CH7441 , 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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