Healthcare Provider Details

I. General information

NPI: 1821718248
Provider Name (Legal Business Name): SPINE CARE CLINICS OF AMERICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S OCEAN BLVD APT 402
PALM BEACH FL
33480-5609
US

IV. Provider business mailing address

3000 S OCEAN BLVD APT 402
PALM BEACH FL
33480-5609
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CYRUS GHAVAM
Title or Position: OWNER
Credential: MD
Phone: 615-446-5121