Provider Demographics
NPI:1962695098
Name:MORENO SPINE AND SCOLIOSIS PLLC
Entity type:Organization
Organization Name:MORENO SPINE AND SCOLIOSIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHOPEDIC SPINE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-669-5300
Mailing Address - Street 1:3251 N MCMULLEN BOOTH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2022
Mailing Address - Country:US
Mailing Address - Phone:727-669-5300
Mailing Address - Fax:727-669-5366
Practice Address - Street 1:3251 N MCMULLEN BOOTH RD STE 301
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761
Practice Address - Country:US
Practice Address - Phone:727-669-5300
Practice Address - Fax:727-669-5366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORENO SPINE AND SCOLIOSIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68236332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6021390001Medicare NSC