Provider Demographics
NPI:1003994047
Name:SCOLIOSIS & SPINE SURGERY CLINIC OF MEMPHIS PLLC
Entity Type:Organization
Organization Name:SCOLIOSIS & SPINE SURGERY CLINIC OF MEMPHIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-767-9500
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5214
Mailing Address - Country:US
Mailing Address - Phone:901-767-9500
Mailing Address - Fax:901-767-0911
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5214
Practice Address - Country:US
Practice Address - Phone:901-767-9500
Practice Address - Fax:901-767-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377615Medicare ID - Type UnspecifiedGROUP MEDICARE
TN4922880001Medicare NSC
TN3377615Medicare ID - Type UnspecifiedTN GROUP MEDICAID