MEDICARE: SPINE AND ORTHOPEDIC SPECIALISTS OF TAMPA, 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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1346886033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND ORTHOPEDIC SPECIALISTS OF TAMPA, LLC

Provider Business Mailing Address
First Line	:	2047 PALM BEACH LAKES BLVD STE 100
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6500
Country	:	US
Telephone Number	:	561-721-6880
Fax Number	:	561-600-8705

Provider Business Practice Location Address
First Line	:	6919 N DALE MABRY HWY STE 325
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3860
Country	:	US
Telephone Number	:	561-507-0800
Fax Number	:	561-600-8705

Authorized Official
Title or Position	:	ASSISTANT ADMIN
Name	:	CARIANNE YANTZ
Credential	:
Telephone Number	:	561-908-3204

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	01/24/2024

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