10D2114491 CLIA NUMBER - BRAIN AND SPINE INSTITUTE OF PORT ORANGE

Laboratory Demographics

CLIA Number: 10D2114491

Facility Name: BRAIN AND SPINE INSTITUTE OF PORT ORANGE

Facility Address:
1211 DUNLAWTON AVE STE 100
PORT ORANGE, FL
ZIP 32127
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Facility Phone Number: 386 304-0111

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699016949

Taxonomy: 2084N0400X - Psychiatry & Neurology
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.

CLIA Record

Field Name	Field Value
CLIA Number	10D2114491
LAB Type	Physician Office
Facility Name	BRAIN AND SPINE INSTITUTE OF PORT ORANGE
Street	1211 DUNLAWTON AVE STE 100
City	PORT ORANGE
State	FL
ZIP	32127
Phone	386 304-0111
CertificateType	4
CertificateEffectiveDate	6/15/2022
CertificateExpirationDate	6/14/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024