Provider Demographics
NPI:1477853752
Name:CENTER FOR NEUROSCIENCES ORTHOPEDICS & SPINE PC
Entity Type:Organization
Organization Name:CENTER FOR NEUROSCIENCES ORTHOPEDICS & SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BOARD OF DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-217-2667
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-1430
Mailing Address - Country:US
Mailing Address - Phone:605-217-2667
Mailing Address - Fax:605-217-2900
Practice Address - Street 1:701 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1666
Practice Address - Country:US
Practice Address - Phone:605-217-2667
Practice Address - Fax:605-217-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1295480004Medicare NSC
IA47935Medicare PIN