Healthcare Provider Details

I. General information

NPI: 1891174355
Provider Name (Legal Business Name): USA SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
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 STE 222
OLDSMAR FL
34677-3711
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 Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN S MAXCY
Title or Position: MD
Credential: MD
Phone: 813-855-8400