Provider Demographics
NPI:1447309018
Name:TOTAL BACK CARE CENTER INC
Entity type:Organization
Organization Name:TOTAL BACK CARE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-434-8707
Mailing Address - Street 1:130 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6224
Mailing Address - Country:US
Mailing Address - Phone:239-434-8707
Mailing Address - Fax:239-434-6343
Practice Address - Street 1:130 TAMIAMI TRL N
Practice Address - Street 2:SUITE 210
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6224
Practice Address - Country:US
Practice Address - Phone:239-434-8707
Practice Address - Fax:239-434-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL950261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65WOtherBLUE CROSS AND BLUE SHIEL
FLF1247Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER