1760534358 NPI number — SOUTHEASTERN SPINE INSTITUTE,LLC

Table of content: (NPI 1760534358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760534358 NPI number — SOUTHEASTERN SPINE INSTITUTE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEASTERN SPINE INSTITUTE,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760534358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 HOSPITAL DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-849-1551
Provider Business Mailing Address Fax Number:
843-849-6591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 HOSPITAL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-3698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-849-1551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRISCH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
843-849-1551

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)