Provider Demographics
NPI:1710344510
Name:SPINE SPECIALISTS OF SOUTH FLORIDA LLC
Entity Type:Organization
Organization Name:SPINE SPECIALISTS OF SOUTH FLORIDA LLC
Other - Org Name:SPINE AND ORTHOPEDIC SPECIALISTS OF SOUTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGICAL SCHEDULER
Authorized Official - Prefix:
Authorized Official - First Name:CARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-507-0800
Mailing Address - Street 1:2047 PALM BEACH LAKES BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6522
Mailing Address - Country:US
Mailing Address - Phone:561-507-0800
Mailing Address - Fax:
Practice Address - Street 1:2047 PALM BEACH LAKES BLVD
Practice Address - Street 2:STE 100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6522
Practice Address - Country:US
Practice Address - Phone:561-507-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015608400Medicaid
FL015608400Medicaid