Healthcare Provider Details

I. General information

NPI: 1760721849
Provider Name (Legal Business Name): CENTRAL SPINE AND ORTHOPEDIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S ANDREWS AVE SUITE 201
POMPANO BEACH FL
33069-3298
US

IV. Provider business mailing address

150 S ANDREWS AVE SUITE 201
POMPANO BEACH FL
33069-3298
US

V. Phone/Fax

Practice location:
  • Phone: 954-476-9494
  • Fax: 954-476-8288
Mailing address:
  • Phone: 954-941-2969
  • Fax: 954-476-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS7123
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME54695
License Number StateFL

VIII. Authorized Official

Name: MRS. STACEY CASTROVINCI
Title or Position: HEAD NURSE MANAGER
Credential: RN
Phone: 954-586-5212