1659827095 NPI number — NEUROSPINE MONITOR, 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 1659827095 NPI number — NEUROSPINE MONITOR, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSPINE MONITOR, 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:
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:
1659827095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14250 BEADLE LAKE RD
Provider Second Line Business Mailing Address:
160
Provider Business Mailing Address City Name:
BATTLE CREEK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49014-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-269-3875
Provider Business Mailing Address Fax Number:
903-328-6568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14250 BEADLE LAKE RD
Provider Second Line Business Practice Location Address:
160
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49014-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-269-3875
Provider Business Practice Location Address Fax Number:
903-328-6568
Provider Enumeration Date:
08/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
214-269-3875

Provider Taxonomy Codes

  • Taxonomy code: 204R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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