MEDICARE: SPINE INSTITUTE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	ME90015	FL

General Provider Information

NPI Number	:	1174848329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE INSTITUTE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 540064
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-0064
Country	:	US
Telephone Number	:	561-965-0436
Fax Number	:	561-965-0452

Provider Business Practice Location Address
First Line	:	4897 S JOG RD STE A
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-5000
Country	:	US
Telephone Number	:	561-965-0436
Fax Number	:	561-965-0452

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN C CHANG
Credential	:	M.D.
Telephone Number	:	561-965-0436

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	05/07/2021

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Directions to “SPINE INSTITUTE, P.A. ” Practice Location

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