Provider Demographics
NPI:1659679645
Name:MCLOVIN ORTHOPAEDICS AND SPINE CENTER
Entity Type:Organization
Organization Name:MCLOVIN ORTHOPAEDICS AND SPINE CENTER
Other - Org Name:BAY ORTHOPAEDICS AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:855-957-7463
Mailing Address - Street 1:PO BOX 5776
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33758-5776
Mailing Address - Country:US
Mailing Address - Phone:352-222-4138
Mailing Address - Fax:
Practice Address - Street 1:5901 SUN BLVD
Practice Address - Street 2:SUITE #206
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-1166
Practice Address - Country:US
Practice Address - Phone:855-957-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty