Provider Demographics
NPI:1386069029
Name:OMNI NEUROLOGICAL ORTHOPEDIC AND SPINE CENTER INC
Entity type:Organization
Organization Name:OMNI NEUROLOGICAL ORTHOPEDIC AND SPINE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MERLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-279-2170
Mailing Address - Street 1:817 S. UNIVERSITY DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-279-2170
Mailing Address - Fax:954-424-9533
Practice Address - Street 1:817 S. UNIVERSITY DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-279-2170
Practice Address - Fax:954-424-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty