Provider Demographics
NPI:1891561874
Name:SPINE AND ORTHO OF MA
Entity Type:Organization
Organization Name:SPINE AND ORTHO OF MA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-507-0800
Mailing Address - Street 1:14283 71ST PL N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4463
Mailing Address - Country:US
Mailing Address - Phone:561-507-0800
Mailing Address - Fax:
Practice Address - Street 1:822 BOYLSTON ST STE 100
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2504
Practice Address - Country:US
Practice Address - Phone:561-507-0800
Practice Address - Fax:561-600-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty