1023271970 NPI number — SPINE DYNAMICS, INC.

Table of content: (NPI 1023271970)

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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