MEDICARE: ALLEGIANCE ORTHOPEDIC NEUROSURGERY AND SPINE INSTITUTE LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1346714797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANCE ORTHOPEDIC NEUROSURGERY AND SPINE INSTITUTE LLC

Provider Business Mailing Address
First Line	:	190 CONGRESS PARK DR STE 160
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4707
Country	:	US
Telephone Number	:	561-306-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 CONGRESS PARK DR STE 160
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4707
Country	:	US
Telephone Number	:	561-306-5383
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER/OWNER
Name	:	DIANE RICCA
Credential	:
Telephone Number	:	561-306-5383

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	07/08/2019

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