Provider Demographics
NPI:1770071789
Name:COLUMBIA ORTHOPAEDIC & SPINE INSTITUTE LLC
Entity type:Organization
Organization Name:COLUMBIA ORTHOPAEDIC & SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENEANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-546-9591
Mailing Address - Street 1:8925 SE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5312
Mailing Address - Country:US
Mailing Address - Phone:772-245-8397
Mailing Address - Fax:
Practice Address - Street 1:3930 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2804
Practice Address - Country:US
Practice Address - Phone:772-245-8397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty