Provider Demographics
NPI:1154148930
Name:SARASOTA LASER AND SPINE CENTER LLC
Entity type:Organization
Organization Name:SARASOTA LASER AND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-678-0264
Mailing Address - Street 1:903 OSBORNE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-4333
Mailing Address - Country:US
Mailing Address - Phone:941-402-4003
Mailing Address - Fax:941-214-9595
Practice Address - Street 1:903 OSBORNE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-4333
Practice Address - Country:US
Practice Address - Phone:941-402-4003
Practice Address - Fax:941-214-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty