Provider Demographics
NPI:1407375744
Name:ORTHO-SPINE CARE AMERICA PLLC
Entity Type:Organization
Organization Name:ORTHO-SPINE CARE AMERICA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-295-6703
Mailing Address - Street 1:1260 37TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6567
Mailing Address - Country:US
Mailing Address - Phone:772-213-9800
Mailing Address - Fax:
Practice Address - Street 1:1260 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6567
Practice Address - Country:US
Practice Address - Phone:772-213-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty