Center for Spine Medicine PA

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

ME 61060 Issued in FL

Legal business name

CENTER FOR SPINE MEDICINE PA

Practice address

3200 SW 34TH Ave
Suite 502
Ocala, FL 34474-7456

Phone

(352) 629-7011

Fax

(352) 629-7924

NPI assigned

Apr 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Charles Michael Grudem, M.D.

Title

President

Phone

(352) 629-7011

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1821218488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SW 34TH AVE",
            "address_2": "SUITE 502",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344747456",
            "telephone_number": "352-629-7011",
            "fax_number": "352-629-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SW 34TH AVE",
            "address_2": "SUITE 502",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344747456",
            "telephone_number": "352-629-7011",
            "fax_number": "352-629-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR SPINE MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "GRUDEM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-629-7011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "FL",
            "license": "ME 61060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "94747",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine Physician in Ocala, FL
• Providers in Ocala, FL by specialty
• Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.