# LASER SPINE SURGERY CENTER OF PENNSYLAVNIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LSI HOLDCO, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1366675316
- **Legal business name:** LSI HOLDCO, LLC
- **Authorized official:** MICHAEL W PERRY MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (813) 289-9613

## Contact information

- **Practice address:** 656 E. SWEDESFORD ROAD, SUITE 105, WAYNE, PA 19087
- **Practice address phone:** (215) 845-0566
- **Practice address fax:** (484) 253-1790
- **Mailing address:** 5332 AVION PARK DRIVE, TAMPA, FL 33607
- **Mailing address phone:** (813) 682-2944
- **Mailing address fax:** (484) 253-1790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/25/2009
- **Last updated:** 01/25/2017