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General NPI Number Information
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NPI Number | 1104233014
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Entity Type | Organization
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Legal Business Name | TAMPA MINIMALLY INVASIVE SPINE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 5329 PRIMROSE LAKE CIR
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City | TAMPA
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State | FL
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Zip | 33647-3521
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Country | US
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Telephone | 813-463-9762
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Fax | 813-463-9764
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Provider Business Mailing Address
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Address Line | 5329 PRIMROSE LAKE CIR
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City | TAMPA
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State | FL
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Zip | 33647-3521
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Country | US
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Telephone | 813-463-9762
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Fax | 813-463-9764
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Authorized Official
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Title or Position | VICE PRESIDENT/DIRECTOR/OFFICER
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Name | MR. CHRISTOPHER TODD JONES
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Credential |
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Telephone | 727-281-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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