1023594801 NPI number — NEUROSPINE GROUP

Table of content: (NPI 1023594801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023594801 NPI number — NEUROSPINE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSPINE GROUP
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:
1023594801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74B CENTENNIAL LOOP STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-7925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-316-6616
Provider Business Mailing Address Fax Number:
541-284-3160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74B CENTENNIAL LOOP STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-7925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-686-3791
Provider Business Practice Location Address Fax Number:
541-686-3795
Provider Enumeration Date:
07/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LEISHMAN
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
541-316-6616

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1033283627 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1033283627 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982899274 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1033192760 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1033192760 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982899274 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1184634594 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1184634594 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477536100 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902000599 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518639038 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831475573 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1902000599 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1477536100 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1831475573 . This is a "COMMERCIAL" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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