Healthcare Provider Details

I. General information

NPI: 1538311345
Provider Name (Legal Business Name): SPINECARE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 KINGSLEY AVE
ORANGE PARK FL
32073-4511
US

IV. Provider business mailing address

5700 MIDNIGHT PASS RD SUITE 4
SARASOTA FL
34242-3083
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-0400
  • Fax:
Mailing address:
  • Phone: 888-337-3509
  • Fax: 941-328-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARL R NOBACK
Title or Position: PRESIDENT
Credential: MD
Phone: 941-360-1566