Healthcare Provider Details

I. General information

NPI: 1891189973
Provider Name (Legal Business Name): AMERICAN SPINE & ORTHOPAEDIC INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7824 LAKE UNDERHILL ROAD SUITE H
ORLANDO FL
32822
US

IV. Provider business mailing address

7824 LAKE UNDERHILL RD STE H
ORLANDO FL
32822-8201
US

V. Phone/Fax

Practice location:
  • Phone: 877-977-7463
  • Fax: 407-792-4152
Mailing address:
  • Phone: 407-440-2728
  • Fax: 407-792-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME82473
License Number StateFL

VIII. Authorized Official

Name: MS. ANA SAAVEDRA
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 407-440-2728