Healthcare Provider Details

I. General information

NPI: 1588142343
Provider Name (Legal Business Name): UA SPINE & JOINT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 HILLSDALE LN
KISSIMMEE FL
34741-7562
US

IV. Provider business mailing address

9842 NOKAY DR
ORLANDO FL
32836-6570
US

V. Phone/Fax

Practice location:
  • Phone: 407-785-1967
  • Fax:
Mailing address:
  • Phone: 407-970-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMER ANSARI
Title or Position: MANAGER
Credential: D.O.
Phone: 407-970-3201