Provider Demographics
NPI:1356325138
Name:SOUTHEASTERN SPINE SPECIALISTS INC
Entity Type:Organization
Organization Name:SOUTHEASTERN SPINE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-750-0447
Mailing Address - Street 1:1781 COMMONS NORTH LOOP
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3577
Mailing Address - Country:US
Mailing Address - Phone:205-750-0447
Mailing Address - Fax:205-750-0276
Practice Address - Street 1:1781 COMMONS NORTH LOOP
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3577
Practice Address - Country:US
Practice Address - Phone:205-750-0447
Practice Address - Fax:205-750-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018074207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC51527770OtherBC/BS
AL051527770Medicaid
AL051527770Medicare PIN
SC51527770OtherBC/BS
AL051527770Medicaid
F82446Medicare UPIN