Provider Demographics
NPI:1760721849
Name:CENTRAL SPINE AND ORTHOPEDIC CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL SPINE AND ORTHOPEDIC CENTER, LLC
Other - Org Name:INTRAOPERATIVE MONITORING SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD NURSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTROVINCI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-586-5212
Mailing Address - Street 1:150 S ANDREWS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-941-2969
Mailing Address - Fax:954-476-8288
Practice Address - Street 1:150 S ANDREWS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-476-9494
Practice Address - Fax:954-476-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7123207R00000X
FLME54695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty