Provider Demographics
NPI:1871817395
Name:FLORIDA SURGICAL SPINE LLC
Entity Type:Organization
Organization Name:FLORIDA SURGICAL SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-261-3598
Mailing Address - Street 1:4925 GREENVILLE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4026
Mailing Address - Country:US
Mailing Address - Phone:214-261-3598
Mailing Address - Fax:866-466-7913
Practice Address - Street 1:1609 PASADENA AVE S
Practice Address - Street 2:SUITE 3-H
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4565
Practice Address - Country:US
Practice Address - Phone:214-261-3598
Practice Address - Fax:866-466-7913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH AMERICAN LASERSCOPIC SPINE INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-26
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty