Provider Demographics
NPI:1942498241
Name:INTERNATIONAL CENTER FOR ADVANCED SPINE AND ORTHOPEDIC SURGERY LLC
Entity Type:Organization
Organization Name:INTERNATIONAL CENTER FOR ADVANCED SPINE AND ORTHOPEDIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAJEEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-465-1204
Mailing Address - Street 1:1922 53RD AVE E STE A
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4236
Mailing Address - Country:US
Mailing Address - Phone:941-753-1756
Mailing Address - Fax:941-201-1200
Practice Address - Street 1:1922 53RD AVE E STE A
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4236
Practice Address - Country:US
Practice Address - Phone:941-753-1756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96223207X00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty