Provider Demographics
NPI:1841755436
Name:BIOSPINE ORLANDO
Entity Type:Organization
Organization Name:BIOSPINE ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RONZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-443-2108
Mailing Address - Street 1:4211 W BOY SCOUT BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5766
Mailing Address - Country:US
Mailing Address - Phone:813-443-2108
Mailing Address - Fax:
Practice Address - Street 1:3900 MILLENIA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6407
Practice Address - Country:US
Practice Address - Phone:407-449-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOSPINE HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-07
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty