1760604409 NPI number — SPINEONE, PLLC

Table of content: (NPI 1760604409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760604409 NPI number — SPINEONE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINEONE, 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:
1760604409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 PARK MEADOWS DRIVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-367-2225
Provider Business Mailing Address Fax Number:
303-343-8702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 PARK MEADOWS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-367-2225
Provider Business Practice Location Address Fax Number:
303-343-8702
Provider Enumeration Date:
05/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
TESSA
Authorized Official Middle Name:
BLAIR
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
303-367-2225

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  32744 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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