Provider Demographics
NPI:1114317757
Name:MID AMERICA SPINE CENTER
Entity Type:Organization
Organization Name:MID AMERICA SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-205-6149
Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3509
Mailing Address - Country:US
Mailing Address - Phone:314-205-6757
Mailing Address - Fax:
Practice Address - Street 1:5139 MATTIS RD STE 100
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-582-1861
Practice Address - Fax:314-590-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical