Provider Demographics
NPI:1275051666
Name:HEALTH AND SPINE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:HEALTH AND SPINE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEL RIO
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:407-931-3700
Mailing Address - Street 1:820 PALMWAY ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4542
Mailing Address - Country:US
Mailing Address - Phone:407-931-3700
Mailing Address - Fax:407-567-7900
Practice Address - Street 1:820 PALMWAY ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4542
Practice Address - Country:US
Practice Address - Phone:407-931-3700
Practice Address - Fax:407-567-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9582111N00000X
FLME87536207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty