Provider Demographics
NPI:1023194032
Name:CENTER FOR SPINE PAIN INC
Entity Type:Organization
Organization Name:CENTER FOR SPINE PAIN INC
Other - Org Name:CENTER FOR SPINE PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:941-256-3875
Mailing Address - Street 1:PO BOX 25006
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2006
Mailing Address - Country:US
Mailing Address - Phone:941-256-3875
Mailing Address - Fax:
Practice Address - Street 1:5741 BEE RIDGE RD
Practice Address - Street 2:STE 210
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5064
Practice Address - Country:US
Practice Address - Phone:941-256-3875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78804208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5401Medicare ID - Type UnspecifiedID#