Spine Center of FL LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

SPINE CENTER OF FL LLC

Practice address

1031 SE 9TH PL
Cape Coral, FL 33990-3003

Phone

(239) 333-1177

Fax

(239) 333-1169

NPI assigned

Sep 20, 2019

Organization subpart

No

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

Authorized official

Name

Douglas W Wisor, MD

Title

Officer

Phone

(703) 927-5772

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1699326744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11921 ROCKVILLE PIKE STE 505",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208522758",
            "telephone_number": "703-789-1929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 SE 9TH PL",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339903003",
            "telephone_number": "239-333-1177",
            "fax_number": "239-333-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE CENTER OF FL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "WISOR",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "703-927-5772",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.