Scuderia Spinale, PLLC

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

SCUDERIA SPINALE, PLLC

Practice address

505 E Main St
Jenks, OK 74037-4136

Phone

(918) 813-3901

Fax

(918) 209-4915

NPI assigned

Jun 8, 2020

Last updated

Oct 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fernando Luis Villamil Wiscovitch, MD

Title

Provider

Phone

(918) 813-3901

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fernando Luis Villamil, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • San Juan, PR
  • NPI 1982647418

  OK

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1104441989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10710 S FIR PL",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740373026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E MAIN ST",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740374136",
            "telephone_number": "918-813-3901",
            "fax_number": "918-209-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCUDERIA SPINALE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-08",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "VILLAMIL WISCOVITCH",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "918-813-3901",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery of the Spine Physician in Jenks, OK
• Providers in Jenks, OK by specialty
• Orthopaedic Surgery of the Spine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.