Organization Name: | ADVANCED SPINE AND WELLNESS |
NPI Number: | 1851661334 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CLARK JEFFREY LEMMON (PRESIDENT) |
Mailing Address: | 1125 1st St S Winter Haven |
State: | FL US |
Postal Code: | 338803902 |
Phone Number: | 8632930040 |
Fax Number: | 8632941419 |
NPI Enumeration Date: | 12/30/2011 |
NPI Last Update Date: | 04/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | CH 9923 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |