Provider Demographics
NPI:1275052458
Name:PENINSULA SPINE INSTITUTE, PS
Entity Type:Organization
Organization Name:PENINSULA SPINE INSTITUTE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-515-2555
Mailing Address - Street 1:2503 CLIFFSIDE LN NW APT V201
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6885
Mailing Address - Country:US
Mailing Address - Phone:360-515-2555
Mailing Address - Fax:206-892-9652
Practice Address - Street 1:804 CALLAHAN DR STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3307
Practice Address - Country:US
Practice Address - Phone:360-515-2555
Practice Address - Fax:206-892-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048961261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty