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General NPI Number Information
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NPI Number | 1407300890
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Entity Type | Organization
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Legal Business Name | NOVUS SPINE, LLC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 631 MID-FLORIDA DRIVE
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City | LAKELAND
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State | FL
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Zip | 33813-4902
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Country | US
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Telephone | 863-583-4445
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Fax | 863-225-5289
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Provider Business Mailing Address
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Address Line | 631 MID FLORIDA DRIVE
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City | LAKELAND
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State | FL
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Zip | 33813-4902
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Country | US
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Telephone | 863-583-4445
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Fax | 863-225-5289
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENITO TORRES
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Credential | DO
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Telephone | 863-583-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine 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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS10656
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License Number State | FL
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