1255466355 NPI number — GREENSBORO SPINE AND SCOLIOSIS CENTER PLLC

Table of content: (NPI 1255466355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255466355 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:
1255466355
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:
2105 BRAXTON LN
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-2861
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:
02/22/2007

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)

  • Identifier: 195939 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 800313 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 131GV . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89131GV . This is a "CAROLINA ACCESS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0900574 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5906042 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00409296 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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