Provider Demographics
NPI:1306862446
Name:BORIS TEREBUH MD LLC
Entity Type:Organization
Organization Name:BORIS TEREBUH MD LLC
Other - Org Name:OHIO SPINE AND MUSCULOSKELETAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:MILAN
Authorized Official - Last Name:TEREBUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-599-4443
Mailing Address - Street 1:6860 PERIMETER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8052
Mailing Address - Country:US
Mailing Address - Phone:937-599-4443
Mailing Address - Fax:937-599-4403
Practice Address - Street 1:6860 PERIMETER DR
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8052
Practice Address - Country:US
Practice Address - Phone:937-599-4443
Practice Address - Fax:937-599-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9362721OtherMEDICARE GROUP
G60381Medicare UPIN