Provider Demographics
NPI:1164749230
Name:SPINE AND JOINT CARE OF SOUTH FLORIDA, LLC
Entity Type:Organization
Organization Name:SPINE AND JOINT CARE OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:BOTELHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-368-5488
Mailing Address - Street 1:875 MEADOWS RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2349
Mailing Address - Country:US
Mailing Address - Phone:561-368-5488
Mailing Address - Fax:
Practice Address - Street 1:875 MEADOWS RD
Practice Address - Street 2:SUITE 311
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2349
Practice Address - Country:US
Practice Address - Phone:561-368-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty