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Organization
CENTER FOR SPINE MEDICINE PA
Active
Organization
CENTER FOR SPINE MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MICHAEL GRUDEM M.D. (PRESIDENT)
(352) 629-7011
Entity
Organization
Contact information
Practice address
3200 SW 34TH AVE, SUITE 502, OCALA, FL 34474-7456
(352) 629-7011
(352) 629-7924
Mailing address
3200 SW 34TH AVE, SUITE 502, OCALA, FL 34474-7456
(352) 629-7011
(352) 629-7924
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
ME 61060
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94747
BCBS GROUP
FL
Enumeration date
04/26/2007
Last updated
06/27/2008
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