Provider Demographics
NPI:1457698433
Name:COMPREHENSIVE SPINE CENTER, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE SPINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KADYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-747-1221
Mailing Address - Street 1:PO BOX 15851
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-5851
Mailing Address - Country:US
Mailing Address - Phone:954-747-1221
Mailing Address - Fax:954-747-1231
Practice Address - Street 1:7710 NW 71ST CT
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2973
Practice Address - Country:US
Practice Address - Phone:954-747-1221
Practice Address - Fax:954-747-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98523207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI908Medicare UPIN