MEDICARE: GULFCOAST 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	207T00000X	Neurological Surgery Physician
2	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1811622160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULFCOAST SPINE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	4211 W BOY SCOUT BLVD STE 400
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5766
Country	:	US
Telephone Number	:	813-443-2108
Fax Number	:	813-443-8255

Provider Business Practice Location Address
First Line	:	6600 UNIVERSITY PKWY STE 204
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-9041
Country	:	US
Telephone Number	:	877-841-8858
Fax Number	:	941-358-9484

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES J RONZO
Credential	:	DO
Telephone Number	:	855-485-3262

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	11/16/2023

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