Provider Demographics
NPI:1225817117
Name:WEST POMPANO SPINE CENTER LLC
Entity Type:Organization
Organization Name:WEST POMPANO SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOELZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-670-3221
Mailing Address - Street 1:2400 W SAMPLE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3035
Mailing Address - Country:US
Mailing Address - Phone:954-580-1036
Mailing Address - Fax:
Practice Address - Street 1:2400 W SAMPLE RD STE 4
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3035
Practice Address - Country:US
Practice Address - Phone:954-580-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty