Jacksonville Spine Center PA

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

JACKSONVILLE SPINE CENTER PA

Practice address

400 Clyde Morris Blvd Unit B1
Ormond Beach, FL 32174-8171

Phone

(904) 223-3321

Fax

(904) 223-2169

NPI assigned

Jun 1, 2022

Organization subpart

No

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

Authorized official

Name

Alicia M Groth

Title

Credentialing

Phone

(904) 223-3321

Specialties & licenses 1

Addresses

Other names 1

• Centurion Spine & Pain Centers Doing business as

Locations

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

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1992444624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY",
            "address_2": "3RD FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32224",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CLYDE MORRIS BLVD UNIT B1",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748171",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE SPINE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "GROTH",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "904-223-3321"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centurion Spine & Pain Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Centurion Spine & Pain Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J.C. Home Care Inc
• Richard A Jablonski, DO
• Patti Jean Jacke, M.A.
• Jackson Reef
• Paul William Jackson, PHARMD
• Kian Fay Jacobs, LCSW
• Erika Leigh Jacumin, PA
• Jaideep Hoskote MD PA
• Christopher Colon Jaime, DPT,PT
• Natasha Jairam, MD

• Interventional Pain Medicine Physician in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.