Provider Demographics
NPI:1104179878
Name:SYNERGY SPINE AND ORTHOPEDIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SYNERGY SPINE AND ORTHOPEDIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:PRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-439-6314
Mailing Address - Street 1:5504 WEST 12 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-838-2035
Mailing Address - Fax:
Practice Address - Street 1:5504 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4684
Practice Address - Country:US
Practice Address - Phone:586-838-2035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical