Healthcare Provider Details

I. General information

NPI: 1659913218
Provider Name (Legal Business Name): NEUSPINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15141 OGDEN LOOP
ODESSA FL
33556-4633
US

IV. Provider business mailing address

2445 COUNTRY PLACE BLVD STE 102
TRINITY FL
34655-1102
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-1186
  • Fax:
Mailing address:
  • Phone: 813-333-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARMEN DEUKMEDJIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 813-333-1186