Healthcare Provider Details

I. General information

NPI: 1508059635
Provider Name (Legal Business Name): MORENO SPINE AND SCOLIOSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MEASE DR
SAFETY HARBOR FL
34695-4659
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 250
TAMPA FL
33607-6383
US

V. Phone/Fax

Practice location:
  • Phone: 727-669-5300
  • Fax: 727-669-5366
Mailing address:
  • Phone: 813-870-1206
  • Fax: 813-887-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberME68236
License Number StateFL

VIII. Authorized Official

Name: ANTHONY P MORENO
Title or Position: PRESIDENT
Credential: MD
Phone: 727-669-5300