MEDICARE: SPINE AND JOINT PAIN RELIEF 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1396596219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND JOINT PAIN RELIEF LLC

Provider Business Mailing Address
First Line	:	1548 ARGYLE DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1542
Country	:	US
Telephone Number	:	800-841-6844
Fax Number	:	954-827-3335

Provider Business Practice Location Address
First Line	:	3275 W HILLSBORO BLVD STE 210
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9476
Country	:	US
Telephone Number	:	800-841-6844
Fax Number	:	954-827-3335

Authorized Official
Title or Position	:	OWNER
Name	:	VINCENTIU POPA
Credential	:	MD
Telephone Number	:	201-925-0277

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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