NPI 1104166735

Brain and Spine Instate for Children

Organisation Preferred Provider Organization Orlando, FL

Practice location

Address: 2813 S Hiawassee Rd Suite 201, Orlando, FL 32835-6300
Phone: (407) 378-5100

Authorised official

Name: Keyne K Johnson
Title: Medical Director
Phone: (407) 378-5100

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence ME 102412 (FL)

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Registry record

NPI: 1104166735
Entity type: Organization
NPI issued: 19 Feb 2013
Record last updated: 19 Feb 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.