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General NPI Number Information
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NPI Number | 1104571629
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Entity Type | Organization
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Legal Business Name | NEXUS SPINE GROUP LLC
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 12437 BRANTLEY COMMONS CT
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City | FORT MYERS
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State | FL
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Zip | 33907-5682
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Country | US
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Telephone | 800-835-9007
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Fax | 239-310-6649
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD # C111-274
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-482-1144
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Fax | 561-482-1145
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ABEL MURILLO
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Credential | MD
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Telephone | 800-835-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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