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General NPI Number Information
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NPI Number | 1821339144
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Entity Type | Organization
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Legal Business Name | BRAIN AND SPINE INSTITUTE FOR CHILDREN LLC
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 06/09/2013
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Provider Practice Location Address
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Address Line | 25 W KALEY ST SUITE 200
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City | ORLANDO
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State | FL
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Zip | 32806-2939
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Country | US
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Telephone | 407-255-2152
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Fax | 407-264-8395
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Provider Business Mailing Address
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Address Line | 25 W KALEY ST SUITE 200
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City | ORLANDO
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State | FL
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Zip | 32806-2939
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Country | US
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Telephone | 407-255-2152
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Fax | 407-264-8395
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | KEYNE K JOHNSON
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Credential | M. D.
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Telephone | 407-378-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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