Provider Demographics
NPI:1255466355
Name:GREENSBORO SPINE AND SCOLIOSIS CENTER PLLC
Entity Type:Organization
Organization Name:GREENSBORO SPINE AND SCOLIOSIS CENTER PLLC
Other - Org Name:SPINE AND SCOLIOSIS SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:W
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-333-6306
Mailing Address - Street 1:2105 BRAXTON LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2861
Mailing Address - Country:US
Mailing Address - Phone:336-333-6306
Mailing Address - Fax:336-333-6309
Practice Address - Street 1:2105 BRAXTON LN
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2861
Practice Address - Country:US
Practice Address - Phone:336-333-6306
Practice Address - Fax:336-333-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200507207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC195939OtherMEDCOST
NC800313OtherPARTNERS
NC131GVOtherBCBS
NC89131GVOtherCAROLINA ACCESS
NC0900574OtherUNITED HEALTHCARE
NC5906042Medicaid
P00409296OtherRAILROAD MEDICARE
P00409296OtherRAILROAD MEDICARE
NCH67358Medicare UPIN
NC800313OtherPARTNERS