Healthcare Provider Details

I. General information

NPI: 1356018691
Provider Name (Legal Business Name): TRINITY SPINE AND ORTHOPEDICS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MONUMENT AVE UNIT 515
KISSIMMEE FL
34741-5779
US

IV. Provider business mailing address

1006 WHITE DR
DELRAY BEACH FL
33483-6527
US

V. Phone/Fax

Practice location:
  • Phone: 561-908-3200
  • Fax: 561-790-8553
Mailing address:
  • Phone: 561-596-6336
  • Fax: 561-790-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN KUPPINGER
Title or Position: OWNER
Credential: MD
Phone: 561-908-3200