# IVY SPINE & ORTHOPEDICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IVY SPINE & ORTHOPEDICS, LLC
- **Other names:** Ivy Spine and Orthopedics, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215534011
- **Legal business name:** IVY SPINE & ORTHOPEDICS, LLC
- **Authorized official:** JENNIFER GATES (PRACTICE MANAGER)
- **Authorized official phone:** (850) 628-7679

## Contact information

- **Practice address:** 2532 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL 32308-4424
- **Practice address phone:** (850) 628-7679
- **Practice address fax:** (850) 257-8099
- **Mailing address:** 2532 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL 32308-4424
- **Mailing address phone:** (850) 628-7679
- **Mailing address fax:** (850) 257-8099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/05/2020
- **Last updated:** 09/07/2021