Healthcare Provider Details

I. General information

NPI: 1609478312
Provider Name (Legal Business Name): PALM BEACH ORTHO-SPINE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 09/25/2021
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4631 N CONGRESS AVE STE 205
WEST PALM BCH FL
33407-3209
US

IV. Provider business mailing address

4631 N CONGRESS AVE STE 205
WEST PALM BEACH FL
33407-3209
US

V. Phone/Fax

Practice location:
  • Phone: 561-725-0540
  • Fax: 561-249-2731
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON BILLINGHURST
Title or Position: PHYSICIAN/OWNER
Credential:
Phone: 561-725-0540