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General NPI Number Information
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NPI Number | 1427689975
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Entity Type | Organization
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Legal Business Name | INTEGRITY SPINE & ORTHOPEDICS OF MELBOURNE LLC
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 1640 HIGHWAY A1A STE C
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-5451
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Country | US
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Telephone | 904-456-0017
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550695
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City | JACKSONVILLE
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State | FL
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Zip | 32255-0695
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Country | US
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Telephone | 904-456-0017
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. TANYA A ALCANTARA
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Credential |
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Telephone | 904-456-0017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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