MEDICARE: PALM BEACH ORTHO-SPINE ASSOCIATES 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	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1609478312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH ORTHO-SPINE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	4631 N CONGRESS AVE STE 205
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4631 N CONGRESS AVE STE 205
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33407-3209
Country	:	US
Telephone Number	:	561-725-0540
Fax Number	:	561-249-2731

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	JASON BILLINGHURST
Credential	:
Telephone Number	:	561-725-0540

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	09/25/2021

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