Provider Demographics
NPI:1487627006
Name:NEUROSURGICAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:NEUROSURGICAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUETTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-894-5511
Mailing Address - Street 1:603 7TH ST S
Mailing Address - Street 2:STE 101
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-894-5511
Mailing Address - Fax:727-822-0135
Practice Address - Street 1:603 7TH ST S
Practice Address - Street 2:STE 101
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-894-5511
Practice Address - Fax:727-822-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN568622207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y3426Medicare ID - Type Unspecified