MEDICARE: ANCHOR SPINE AND JOINT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician
2	208VP0014X	Interventional Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205249026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHOR SPINE AND JOINT LLC

Provider Business Mailing Address
First Line	:	10730 KETCHUM VALLEY DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7185
Country	:	US
Telephone Number	:	813-331-4465
Fax Number	:	813-280-4855

Provider Business Practice Location Address
First Line	:	10726 KETCHUM VALLEY DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7185
Country	:	US
Telephone Number	:	813-331-4465
Fax Number	:	813-280-4855

Authorized Official
Title or Position	:	OWNER
Name	:	NIKHIL H PATEL
Credential	:	MD
Telephone Number	:	813-331-4465

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	05/17/2023

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Directions to “ANCHOR SPINE AND JOINT LLC ” Practice Location

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