Provider Demographics
NPI:1447395850
Name:AURORA SPINE CENTERS-MISSISSIPPI, INC
Entity Type:Organization
Organization Name:AURORA SPINE CENTERS-MISSISSIPPI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-841-7585
Mailing Address - Street 1:PO BOX 3660
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3660
Mailing Address - Country:US
Mailing Address - Phone:662-841-7585
Mailing Address - Fax:662-841-2667
Practice Address - Street 1:408 COUNCIL CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4949
Practice Address - Country:US
Practice Address - Phone:662-841-7585
Practice Address - Fax:662-841-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02891Medicare PIN
MS0595030001Medicare NSC