Basic Information
| Provider Information | |||||||||
| NPI: | 1225675804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA SPINE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 GLADES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614959511 | ||||||||
| FaxNumber: | 5619907426 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 GLADES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614959511 | ||||||||
| FaxNumber: | 5619907426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2019 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROSARIO | ||||||||
| AuthorizedOfficialFirstName: | BRITTANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5614959511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | 207XS0117X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1396830386 | 01 | FL | WORKERS COMP AND AUTO | OTHER |