Provider Demographics
NPI:1275231466
Name:ADVANCED JOINT AND SPINE INSTITUTE-ORLANDO, LLC
Entity type:Organization
Organization Name:ADVANCED JOINT AND SPINE INSTITUTE-ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKET PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TOMLINSON
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:303-396-9391
Mailing Address - Street 1:7974 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8229
Mailing Address - Country:US
Mailing Address - Phone:321-710-9899
Mailing Address - Fax:
Practice Address - Street 1:7974 LAKE UNDERHILL ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-256-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical