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General NPI Number Information
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NPI Number | 1538311345
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Entity Type | Organization
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Legal Business Name | SPINECARE ANESTHESIA LLC
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 1564 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4511
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Country | US
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Telephone | 904-264-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 MIDNIGHT PASS RD SUITE 4
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City | SARASOTA
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State | FL
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Zip | 34242-3083
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Country | US
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Telephone | 888-337-3509
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Fax | 941-328-3997
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL R NOBACK
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Credential | MD
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Telephone | 941-360-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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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