Provider Demographics
NPI:1861669194
Name:ORTHOPAEDIC SPINE & FRACTURE CENTER, LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPINE & FRACTURE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-296-2345
Mailing Address - Street 1:12983 SOUTHERN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9254
Mailing Address - Country:US
Mailing Address - Phone:561-296-2345
Mailing Address - Fax:561-296-2346
Practice Address - Street 1:12983 SOUTHERN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9254
Practice Address - Country:US
Practice Address - Phone:561-296-2345
Practice Address - Fax:561-296-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81924207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty