Provider Demographics
NPI:1861406720
Name:ORANGE PARK NEUROSURGERY P.L.
Entity type:Organization
Organization Name:ORANGE PARK NEUROSURGERY P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPATOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-276-3376
Mailing Address - Street 1:2021 KINGSLEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5174
Mailing Address - Country:US
Mailing Address - Phone:904-276-3376
Mailing Address - Fax:904-276-5308
Practice Address - Street 1:2021 KINGSLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:904-276-3376
Practice Address - Fax:904-276-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7538OtherMEDICARE PTAN