Provider Demographics
NPI:1679042972
Name:AMERICAN SPINE & ORTHOPAEDIC INSTITUTE LLC
Entity type:Organization
Organization Name:AMERICAN SPINE & ORTHOPAEDIC INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-440-2728
Mailing Address - Street 1:3724 WINTER GARDEN VINELAND RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5483
Mailing Address - Country:US
Mailing Address - Phone:877-977-7463
Mailing Address - Fax:
Practice Address - Street 1:3724 WINTER GARDEN VINELAND RD BLDG 2
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5483
Practice Address - Country:US
Practice Address - Phone:877-977-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty