Provider Demographics
NPI:1891174355
Name:USA SPINE LLC
Entity Type:Organization
Organization Name:USA SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAXCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-855-8400
Mailing Address - Street 1:300 STATE ST E STE 222
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3711
Mailing Address - Country:US
Mailing Address - Phone:813-855-8400
Mailing Address - Fax:813-855-9200
Practice Address - Street 1:300 STATE ST E STE 222
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3711
Practice Address - Country:US
Practice Address - Phone:813-855-8400
Practice Address - Fax:813-855-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty