Provider Demographics
NPI:1972093946
Name:TOTAL SPINE CARE, LLC
Entity Type:Organization
Organization Name:TOTAL SPINE CARE, LLC
Other - Org Name:LASER SPINE INSTITUTE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LIC/CRED MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-392-7604
Mailing Address - Street 1:5332 AVION PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1412
Mailing Address - Country:US
Mailing Address - Phone:813-289-9613
Mailing Address - Fax:484-253-1790
Practice Address - Street 1:644 EDEN PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6031
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:484-253-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201812204520261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service