Provider Demographics
NPI:1720590953
Name:BRAIN AND SPINE NEUROSCIENCE INSTITUTE, LLC
Entity Type:Organization
Organization Name:BRAIN AND SPINE NEUROSCIENCE INSTITUTE, LLC
Other - Org Name:THE FLORIDA CENTER FOR MINIMALLY INVASIVE NEUROSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-336-4461
Mailing Address - Street 1:3519 PALM HARBOR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1416
Mailing Address - Country:US
Mailing Address - Phone:813-336-4461
Mailing Address - Fax:813-336-4466
Practice Address - Street 1:13121 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1812
Practice Address - Country:US
Practice Address - Phone:813-336-4461
Practice Address - Fax:813-336-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty