Healthcare Provider Details

I. General information

NPI: 1417351040
Provider Name (Legal Business Name): USA SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST E STE 222
OLDSMAR FL
34677-3711
US

IV. Provider business mailing address

300 STATE ST E
OLDSMAR FL
34677-3702
US

V. Phone/Fax

Practice location:
  • Phone: 813-855-8400
  • Fax: 813-855-9200
Mailing address:
  • Phone: 813-855-8400
  • Fax: 813-855-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. COLLEEN S MAXCY
Title or Position: OWNER
Credential: MD, MPH
Phone: 813-855-8400