Provider Demographics
NPI:1326214875
Name:THE SPINE MANAGEMENT CENTER,LLC
Entity Type:Organization
Organization Name:THE SPINE MANAGEMENT CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:WARING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-641-8008
Mailing Address - Street 1:PO BOX 3249
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-3249
Mailing Address - Country:US
Mailing Address - Phone:985-641-8008
Mailing Address - Fax:
Practice Address - Street 1:105 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5544
Practice Address - Country:US
Practice Address - Phone:985-641-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty