Provider Demographics
NPI:1609167592
Name:SPINE INSTITUTE OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD , MBA
Authorized Official - Phone:863-688-3030
Mailing Address - Street 1:1301 GRASSLANDS BOULVARD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5401
Mailing Address - Country:US
Mailing Address - Phone:863-688-3030
Mailing Address - Fax:
Practice Address - Street 1:1301 GRASSLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5401
Practice Address - Country:US
Practice Address - Phone:863-688-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104463261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001188600Medicaid
FLCA675ZMedicare PIN