Provider Demographics
NPI:1265485924
Name:SPINE AND ORTHOPAEDIC MEDICAL CENTER
Entity Type:Organization
Organization Name:SPINE AND ORTHOPAEDIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-449-7645
Mailing Address - Street 1:8405 N FRESNO ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1537
Mailing Address - Country:US
Mailing Address - Phone:559-449-7645
Mailing Address - Fax:559-432-1915
Practice Address - Street 1:8405 N FRESNO ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1538
Practice Address - Country:US
Practice Address - Phone:559-449-7645
Practice Address - Fax:559-432-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21716ZMedicare PIN
CAZZZ21716ZMedicare ID - Type Unspecified
CA0957490001Medicare NSC