Provider Demographics
NPI:1861957425
Name:GALAXY WELLNESS & ORTHO-SPINE CENTER LLC
Entity type:Organization
Organization Name:GALAXY WELLNESS & ORTHO-SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-536-2377
Mailing Address - Street 1:9774 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7574
Mailing Address - Country:US
Mailing Address - Phone:786-536-2377
Mailing Address - Fax:888-862-2545
Practice Address - Street 1:9774 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7574
Practice Address - Country:US
Practice Address - Phone:865-362-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0270619900Medicaid