Provider Demographics
NPI:1942675251
Name:INTEGRATED SPINE AND PAIN CENTER OF FLORIDA INC
Entity Type:Organization
Organization Name:INTEGRATED SPINE AND PAIN CENTER OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOLDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-381-2800
Mailing Address - Street 1:29141 CHAPEL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4423
Mailing Address - Country:US
Mailing Address - Phone:813-994-5200
Mailing Address - Fax:813-994-5700
Practice Address - Street 1:29141 CHAPEL PARK DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-4423
Practice Address - Country:US
Practice Address - Phone:813-994-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty