Provider Demographics
NPI:1972062685
Name:360 ORTHO AND SPINE LLC
Entity type:Organization
Organization Name:360 ORTHO AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-367-4968
Mailing Address - Street 1:11809 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3505
Mailing Address - Country:US
Mailing Address - Phone:833-367-4968
Mailing Address - Fax:833-367-4968
Practice Address - Street 1:11809 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3505
Practice Address - Country:US
Practice Address - Phone:833-367-4968
Practice Address - Fax:833-367-4968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:360 ORTHO AND SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-13
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty