Provider Demographics
NPI:1407300890
Name:NOVUS SPINE, LLC
Entity Type:Organization
Organization Name:NOVUS SPINE, LLC
Other - Org Name:NOVUS SPINE & PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENITO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-583-4445
Mailing Address - Street 1:631 MID FLORIDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4902
Mailing Address - Country:US
Mailing Address - Phone:863-583-4445
Mailing Address - Fax:863-225-5289
Practice Address - Street 1:631 MID-FLORIDA DRIVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4902
Practice Address - Country:US
Practice Address - Phone:863-583-4445
Practice Address - Fax:863-225-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS106562081P2900X
208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty