Provider Demographics
NPI:1093236283
Name:SPINE MANAGEMENT GROUP, LLC
Entity Type:Organization
Organization Name:SPINE MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-394-0001
Mailing Address - Street 1:4600 S CLAIBORNE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-5010
Mailing Address - Country:US
Mailing Address - Phone:504-899-2225
Mailing Address - Fax:504-899-2280
Practice Address - Street 1:4600 S CLAIBORNE AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-5010
Practice Address - Country:US
Practice Address - Phone:504-899-2225
Practice Address - Fax:504-899-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2011442081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306036942OtherPM&R AND INTERVENTIONAL SPINE AND PAIN MEDICINE