1023271970 NPI number — SPINE DYNAMICS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023271970 NPI number — SPINE DYNAMICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE DYNAMICS, INC.
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:
1023271970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 ENFIELD ST
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
ENFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06082-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-741-2187
Provider Business Mailing Address Fax Number:
860-741-2188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 ENFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-741-2187
Provider Business Practice Location Address Fax Number:
860-741-2188
Provider Enumeration Date:
07/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CATO
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
860-741-2187

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  001548 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CT15480 . This is a "LANDMARK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 659634 . This is a "UHC, HNE, ACN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P00271268 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 105007 . This is a "ASHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P3240793 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 050001548CT01 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7127580 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9385151 . This is a "PHCS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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