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NPI Code Detail

MEDICARE: INTERVENTIONAL SPINE INSTITUTE OF FLORIDA

MEDICARE: INTERVENTIONAL SPINE INSTITUTE OF FLORIDA
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
1174400000XSpecialist60952FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2K5708OTHERFLMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME76009OTHERFLMEDICAL LICENSE
31326453143OTHERFLNPI-DME-MELBOURNE
410708014OTHERFLCAQH
51225060338OTHERFLNPI GROUP
61639101744OTHERFLNPI INDIVIDUAL

General Provider Information

NPI Number : 1386053106
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERVENTIONAL SPINE INSTITUTE OF FLORIDA
Provider Business Mailing Address
First Line : 308 S HARBOR CITY BLVD
Second Line : SUITE A
City : MELBOURNE
State : FL
Zip : 32901-1500
Country : US
Telephone Number : 321-733-0064
Fax Number : 321-733-7970
Provider Business Practice Location Address
First Line : 389 COMMERCE PKWY
Second Line : SUITE 120
City : ROCKLEDGE
State : FL
Zip : 32955-4202
Country : US
Telephone Number : 321-733-0064
Fax Number : 321-733-7970
Authorized Official
Title or Position : OWNER/CEO/PRESIDENT
Name : DR. BRIAN C DOWDELL
Credential : M.D.
Telephone Number : 321-733-0064
Provider Enumeration Date : 08/06/2014
Last Update Date : 03/07/2023

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Directions to “INTERVENTIONAL SPINE INSTITUTE OF FLORIDA ” Practice Location

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