Provider Demographics
NPI:1023642428
Name:CENTRAL FLORIDA SPINE INSTITUTE, PLLC - SUMMERFIELD
Entity type:Organization
Organization Name:CENTRAL FLORIDA SPINE INSTITUTE, PLLC - SUMMERFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-873-7770
Mailing Address - Street 1:2102 SW 20TH PL BLDG 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0856
Mailing Address - Country:US
Mailing Address - Phone:352-873-7770
Mailing Address - Fax:352-873-7704
Practice Address - Street 1:17820 SE 109TH AVE STE 106B
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-873-7770
Practice Address - Fax:352-873-7704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL FLORIDA SPINE INSTITUTE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty