Provider Demographics
NPI:1215296967
Name:MINIMALLY INVASIVE SPINE CENTER LLC
Entity type:Organization
Organization Name:MINIMALLY INVASIVE SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-733-8133
Mailing Address - Street 1:2401 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6514
Mailing Address - Country:US
Mailing Address - Phone:561-733-8133
Mailing Address - Fax:561-733-6670
Practice Address - Street 1:2314 S SEACREST BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6788
Practice Address - Country:US
Practice Address - Phone:561-733-8133
Practice Address - Fax:561-733-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical