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General NPI Number Information
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NPI Number | 1366989246
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Entity Type | Organization
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Legal Business Name | ORANGE PARK SPINE INSTITUTE LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE SUITE 1D
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-504-7767
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Fax | 904-375-1761
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Provider Business Mailing Address
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Address Line | 1409 KINGSLEY AVE SUITE 1D
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-504-7767
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Fax | 904-375-1761
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Authorized Official
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Title or Position | PRESIDENT/SURGEON
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Name | DR. CONSTANTINE ANDREW TOUMBIS
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Credential | MD, PHD
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Telephone | 352-257-3391
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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 | ME80012
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License Number State | FL
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