Provider Demographics
NPI:1821339144
Name:BRAIN AND SPINE INSTITUTE FOR CHILDREN LLC
Entity Type:Organization
Organization Name:BRAIN AND SPINE INSTITUTE FOR CHILDREN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:407-378-5100
Mailing Address - Street 1:25 W KALEY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2939
Mailing Address - Country:US
Mailing Address - Phone:407-255-2152
Mailing Address - Fax:407-264-8395
Practice Address - Street 1:25 W KALEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2939
Practice Address - Country:US
Practice Address - Phone:407-255-2152
Practice Address - Fax:407-264-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty