Provider Demographics
NPI:1588944862
Name:SPINECARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SPINECARE ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-797-7463
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:3280 MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2046
Practice Address - Country:US
Practice Address - Phone:727-797-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINECARE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-18
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site