Provider Demographics
NPI:1629766969
Name:MIS NEUROSPINE LLC
Entity Type:Organization
Organization Name:MIS NEUROSPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-236-8933
Mailing Address - Street 1:1711 AMAZING WAY STE 209
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3491
Mailing Address - Country:US
Mailing Address - Phone:239-236-8933
Mailing Address - Fax:
Practice Address - Street 1:12468 BRANTLEY COMMONS CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5663
Practice Address - Country:US
Practice Address - Phone:239-236-8933
Practice Address - Fax:407-650-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty