Provider Demographics
NPI:1497703656
Name:SPINE & SCOLIOSIS CENTER, P.A.
Entity Type:Organization
Organization Name:SPINE & SCOLIOSIS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-849-1200
Mailing Address - Street 1:104 PARK PLACE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6866
Mailing Address - Country:US
Mailing Address - Phone:407-849-1200
Mailing Address - Fax:407-841-7539
Practice Address - Street 1:104 PARK PLACE BLVD STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6866
Practice Address - Country:US
Practice Address - Phone:407-849-1200
Practice Address - Fax:407-841-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40695Medicare ID - Type Unspecified