1558304212 NPI number — BRAIN & SPINE NEUROSURGICAL INSTITUTE, LLC

Table of content: (NPI 1558304212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558304212 NPI number — BRAIN & SPINE NEUROSURGICAL INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAIN & SPINE NEUROSURGICAL INSTITUTE, LLC
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:
1558304212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 THURBER BLVD
Provider Second Line Business Mailing Address:
UNIT 6
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02917-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-404-2975
Provider Business Mailing Address Fax Number:
404-404-2976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1526 ATWOOD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-270-5395
Provider Business Practice Location Address Fax Number:
401-270-7635
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAS
Authorized Official First Name:
SUMIT
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-270-5395

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SD50629 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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