Provider Demographics
NPI:1235529272
Name:ILBNC, P.A.
Entity Type:Organization
Organization Name:ILBNC, P.A.
Other - Org Name:INSTITUTE FOR LOW BACK & NECK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SURGERY CENTER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WILFRED
Authorized Official - Last Name:JUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-814-6600
Mailing Address - Street 1:3001 METRO DRIVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4506
Mailing Address - Country:US
Mailing Address - Phone:952-814-6600
Mailing Address - Fax:952-814-6700
Practice Address - Street 1:15700 37TH AVENUE NORTH
Practice Address - Street 2:SUITE 210
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3662
Practice Address - Country:US
Practice Address - Phone:952-814-6600
Practice Address - Fax:952-814-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365578207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty