# JACKSONVILLE SPINE CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jax Spine & Pain Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881643757
- **Authorized official:** ALICIA M GROTH (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (904) 223-3321

## Contact information

- **Practice address:** 5191 FIRST COAST TECH PKWY, JACKSONVILLE, FL 32224
- **Practice address phone:** (904) 223-3321
- **Practice address fax:** (904) 223-2169
- **Mailing address:** 5191 FIRST COAST TECH PKWY, 3RD FLOOR, JACKSONVILLE, FL 32224
- **Mailing address phone:** (904) 223-3321
- **Mailing address fax:** (904) 223-2169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 05/09/2023