Provider Demographics
NPI:1871398016
Name:MEDSPORT SPINE LLC
Entity type:Organization
Organization Name:MEDSPORT SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENTIU
Authorized Official - Middle Name:
Authorized Official - Last Name:POPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-925-0277
Mailing Address - Street 1:3836 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9413
Mailing Address - Country:US
Mailing Address - Phone:954-421-2355
Mailing Address - Fax:
Practice Address - Street 1:3836 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9413
Practice Address - Country:US
Practice Address - Phone:954-421-2355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty