Provider Demographics
NPI:1609478312
Name:PALM BEACH ORTHO-SPINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:PALM BEACH ORTHO-SPINE ASSOCIATES LLC
Other - Org Name:INTEGRAMED SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-725-0540
Mailing Address - Street 1:4631 N CONGRESS AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4631 N CONGRESS AVE STE 205
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33407-3209
Practice Address - Country:US
Practice Address - Phone:561-725-0540
Practice Address - Fax:561-249-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty