Provider Demographics
NPI:1881022903
Name:SPINE SPECIALISTS OF AMERICA LLC
Entity type:Organization
Organization Name:SPINE SPECIALISTS OF AMERICA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROTEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-474-9729
Mailing Address - Street 1:13035 W LINEBAUGH AVE STE 101F
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4481
Mailing Address - Country:US
Mailing Address - Phone:727-474-9729
Mailing Address - Fax:727-474-9947
Practice Address - Street 1:13035 W LINEBAUGH AVE STE 101F
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4481
Practice Address - Country:US
Practice Address - Phone:727-474-9729
Practice Address - Fax:727-474-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54499207XS0117X
FLME115987208VP0014X
FLME85743208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty