Provider Demographics
NPI:1922195171
Name:CENTRAL FLORIDA SPINE INSTITUTE, PLLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA SPINE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARAISO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-873-7770
Mailing Address - Street 1:2102 SW 20TH PL STE 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0861
Mailing Address - Country:US
Mailing Address - Phone:352-873-7770
Mailing Address - Fax:352-873-7704
Practice Address - Street 1:2102 SW 20TH PL # 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0861
Practice Address - Country:US
Practice Address - Phone:352-873-7770
Practice Address - Fax:352-873-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XS0117X
FLOS9151207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269596100Medicaid
FL6136100001Medicare NSC
AB164Medicare PIN
FLI11095Medicare UPIN
FL269596100Medicaid