1114340213 NPI number — GREENSBORO SPINE AND SCOLIOSIS CENTER, PLLC

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 1114340213 NPI number — GREENSBORO SPINE AND SCOLIOSIS CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENSBORO SPINE AND SCOLIOSIS CENTER, PLLC
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:
6
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:
1114340213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 BRAXTON LN
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27408-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-333-6306
Provider Business Mailing Address Fax Number:
336-333-6309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4590 PREMIER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-8193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-333-6306
Provider Business Practice Location Address Fax Number:
336-333-6309
Provider Enumeration Date:
01/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
MAX
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-333-6306

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X , with the licence number:  200200507 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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