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BRAIN AND SPINE INSTITUTE OF PORT ORANGE LLC NPI 1699016949


NPI Information

NPI: 1699016949
Provider Name: BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

CLIA Number: 10D2114491

Address:
1211 DUNLAWTON AVE
PORT ORANGE, FL
ZIP 32127
Phone: (386) 304-0111
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BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC is a neurology psychiatry neurology in Port Orange, FL. The provider is 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. BRAIN AND SPINE INSTITUTE OF PORT ORANGE, LLC NPI is 1699016949. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1211 DUNLAWTON AVE
PORT ORANGE, FL
ZIP 32127-913
Phone: (386) 304-0111

The provider's authorized official is Timothy Joseph Wierzbicki .
The authorized official title is Ceo and has the following contact phone number (386) 304-0111.

The CLIA number assigned to this NPI record is 10D2114491 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/12/2013 and was last updated on 3/15/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084N0400XPsychiatry & NeurologyNeurologyME80334FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
135363XMEDICARE PINFLORIDA
2130022355OTHERFLORIDAMEDICARE RAILROAD
3259058100MEDICAIDFLORIDA
4H16730MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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