Provider Demographics
NPI:1801394440
Name:NEUSPINE THERAPY LLC
Entity type:Organization
Organization Name:NEUSPINE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUKMEDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-333-1186
Mailing Address - Street 1:2653 BRUCE B DOWNS BLVD STE 108-168
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9206
Mailing Address - Country:US
Mailing Address - Phone:813-997-2099
Mailing Address - Fax:813-280-6193
Practice Address - Street 1:12880 US 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5801
Practice Address - Country:US
Practice Address - Phone:813-388-2935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUSPINE ANCILLARY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-29
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty