Provider Demographics
NPI:1073994935
Name:RECOIL SPINAL SYSTEMS, LLC
Entity Type:Organization
Organization Name:RECOIL SPINAL SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-858-4533
Mailing Address - Street 1:4090 JEFFREY BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2338
Mailing Address - Country:US
Mailing Address - Phone:844-473-2645
Mailing Address - Fax:
Practice Address - Street 1:4090 JEFFREY BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14219-2338
Practice Address - Country:US
Practice Address - Phone:844-473-2645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MDC17849332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment