Healthcare Provider Details

I. General information

NPI: 1487908893
Provider Name (Legal Business Name): SPINE INJURY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W MARTIN LUTHER KING BLVD SUITE 1
TAMPA FL
33603
US

IV. Provider business mailing address

607 W. MARTIN LUTHER KING BLVD SUITE 1
TAMPA FL
33603
US

V. Phone/Fax

Practice location:
  • Phone: 813-463-0225
  • Fax: 813-237-2149
Mailing address:
  • Phone: 813-463-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME46811
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME54499
License Number StateFL

VIII. Authorized Official

Name: DR. ERIC K GROTEKE
Title or Position: MEMBER
Credential: DC
Phone: 727-474-9729