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General NPI Number Information
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NPI Number | 1417351040
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Entity Type | Organization
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Legal Business Name | USA SPINE LLC
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 300 STATE ST E STE 222
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City | OLDSMAR
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State | FL
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Zip | 34677-3711
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Country | US
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Telephone | 813-855-8400
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Fax | 813-855-9200
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Provider Business Mailing Address
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Address Line | 300 STATE ST E
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City | OLDSMAR
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State | FL
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Zip | 34677-3702
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Country | US
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Telephone | 813-855-8400
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Fax | 813-855-9200
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Authorized Official
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Title or Position | OWNER
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Name | DR. COLLEEN S MAXCY
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Credential | MD, MPH
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Telephone | 813-855-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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