Provider Demographics
NPI:1023891546
Name:NEUSPINE INSTITUTE, LLC
Entity type:Organization
Organization Name:NEUSPINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUKMEDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-610-5102
Mailing Address - Street 1:2590 HEALING WAY STE 310
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5497
Mailing Address - Country:US
Mailing Address - Phone:813-333-1186
Mailing Address - Fax:844-691-5928
Practice Address - Street 1:24620 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7307
Practice Address - Country:US
Practice Address - Phone:813-333-9936
Practice Address - Fax:844-691-5928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUSPINE INSTITUTE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty