Provider Demographics
NPI:1154747566
Name:BIOSPINE LLC
Entity type:Organization
Organization Name:BIOSPINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RONZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-443-2108
Mailing Address - Street 1:4211 W BOY SCOUT BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5724
Mailing Address - Country:US
Mailing Address - Phone:855-485-3262
Mailing Address - Fax:813-443-8255
Practice Address - Street 1:5301 AVION PARK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1416
Practice Address - Country:US
Practice Address - Phone:855-485-3262
Practice Address - Fax:813-443-8255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOSPINE HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-10
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical