MEDICARE: SPINAL DISORDERS AND PAIN TREATMENT INSTITUTE

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	207T00000X	Neurological Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	GRP DG0621	OTHER	FL	RR MEDICARE
3	P00412279	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710929211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL DISORDERS AND PAIN TREATMENT INSTITUTE

Provider Business Mailing Address
First Line	:	6006 49TH ST N
Second Line	:	SUITE 350
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2148
Country	:	US
Telephone Number	:	727-521-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	6006 49TH ST N
Second Line	:	SUITE 350
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-2148
Country	:	US
Telephone Number	:	727-521-5489
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	ROBERT ENGLAND
Credential	:
Telephone Number	:	727-521-5489

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/11/2008

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