1578685368 NPI number — NEUROSURGERY SPINE & PAIN ASSOC PC

Table of content: (NPI 1578685368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578685368 NPI number — NEUROSURGERY SPINE & PAIN ASSOC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGERY SPINE & PAIN ASSOC PC
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:
1578685368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3S220 WARREN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60555-2914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-393-2222
Provider Business Mailing Address Fax Number:
630-393-2221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3S220 WARREN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60555-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-393-2222
Provider Business Practice Location Address Fax Number:
630-393-2221
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
HILL
Authorized Official Title or Position:
BUSINESS MANAGER / TREASURER
Authorized Official Telephone Number:
630-452-1467

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  036072169 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1316034010 . This is a "DR. MATTHEW ROSS NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036072169 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com