Provider Demographics
NPI:1346886033
Name:SPINE AND ORTHOPEDIC SPECIALISTS OF TAMPA, LLC
Entity Type:Organization
Organization Name:SPINE AND ORTHOPEDIC SPECIALISTS OF TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-908-3204
Mailing Address - Street 1:2047 PALM BEACH LAKES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6500
Mailing Address - Country:US
Mailing Address - Phone:561-721-6880
Mailing Address - Fax:561-600-8705
Practice Address - Street 1:6919 N DALE MABRY HWY STE 325
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3860
Practice Address - Country:US
Practice Address - Phone:561-507-0800
Practice Address - Fax:561-600-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty