Provider Demographics
NPI:1033255625
Name:NEUROSURGERY AND SPINE SURGERY SC
Entity Type:Organization
Organization Name:NEUROSURGERY AND SPINE SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODER/BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PFLIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-983-7100
Mailing Address - Street 1:1551 BOND ST
Mailing Address - Street 2:SUITE 143
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-0112
Mailing Address - Country:US
Mailing Address - Phone:630-983-7100
Mailing Address - Fax:630-983-6331
Practice Address - Street 1:1551 BOND ST
Practice Address - Street 2:SUITE 143
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-0112
Practice Address - Country:US
Practice Address - Phone:630-983-7100
Practice Address - Fax:630-983-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042001653036091593207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
130942100OtherACS
4515366OtherBCBS
CM8165OtherRR MCARE
CM8165OtherRR MCARE
IL0549760001Medicare NSC