Provider Demographics
NPI:1174040828
Name:GULFCOAST SPINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:GULFCOAST SPINE INSTITUTE, LLC
Other - Org Name:BIOSPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:RONZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-443-2108
Mailing Address - Street 1:4211 W BOY SCOUT BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5766
Mailing Address - Country:US
Mailing Address - Phone:813-443-2108
Mailing Address - Fax:813-284-7952
Practice Address - Street 1:3902 MILLENIA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6407
Practice Address - Country:US
Practice Address - Phone:813-443-2108
Practice Address - Fax:813-284-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty