Provider Demographics
NPI:1851718563
Name:PHYSICIANS BACK & NECK CENTER ORLANDO INC
Entity Type:Organization
Organization Name:PHYSICIANS BACK & NECK CENTER ORLANDO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRASURE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:407-412-9226
Mailing Address - Street 1:5979 VINELAND RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7800
Mailing Address - Country:US
Mailing Address - Phone:407-412-9226
Mailing Address - Fax:407-650-2888
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-412-9226
Practice Address - Fax:407-650-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69749261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF67953Medicare UPIN