MEDICARE: NEURO SURGERY & ORTHOPEDIC SPINE INSTITUTE PA

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	207T00000X	Neurological Surgery Physician	ME71047	FL
2	207X00000X	Orthopaedic Surgery Physician	ME99159	FL

General Provider Information

NPI Number	:	1558696492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO SURGERY & ORTHOPEDIC SPINE INSTITUTE PA

Provider Business Mailing Address
First Line	:	2623 S SEACREST BLVD STE 118
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7531
Country	:	US
Telephone Number	:	561-742-4419
Fax Number	:	561-742-0413

Provider Business Practice Location Address
First Line	:	2623 S SEACREST BLVD STE 118
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7531
Country	:	US
Telephone Number	:	561-742-4419
Fax Number	:	561-742-0413

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MRS. ELIZABETH PALOMO
Credential	:
Telephone Number	:	561-620-3025

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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