Provider Demographics
NPI:1407969678
Name:ASSOCIATES IN NEUROSURGERY, PA
Entity Type:Organization
Organization Name:ASSOCIATES IN NEUROSURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:ST LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-898-8644
Mailing Address - Street 1:532 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1856
Mailing Address - Country:US
Mailing Address - Phone:407-898-8644
Mailing Address - Fax:407-898-8646
Practice Address - Street 1:532 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1856
Practice Address - Country:US
Practice Address - Phone:407-898-8644
Practice Address - Fax:407-898-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42806174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6371960001Medicare NSC
FLK1121Medicare ID - Type UnspecifiedMEDCARE GROUP NUMBER