Provider Demographics
NPI:1093915779
Name:SPINE SPECIALISTS P C
Entity Type:Organization
Organization Name:SPINE SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-294-0080
Mailing Address - Street 1:2000 S WHEELING AVE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5649
Mailing Address - Country:US
Mailing Address - Phone:918-294-0080
Mailing Address - Fax:918-294-3899
Practice Address - Street 1:2000 S WHEELING AVE
Practice Address - Street 2:SUITE 1110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5649
Practice Address - Country:US
Practice Address - Phone:918-294-0080
Practice Address - Fax:918-294-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15014207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522001Medicare PIN