Provider Demographics
NPI:1497898076
Name:DURHAM REGIONAL SPINE CENTER
Entity Type:Organization
Organization Name:DURHAM REGIONAL SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEGROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-620-7900
Mailing Address - Street 1:400 CRUTCHFIELD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2771
Mailing Address - Country:US
Mailing Address - Phone:919-620-7900
Mailing Address - Fax:919-479-5061
Practice Address - Street 1:400 CRUTCHFIELD ST
Practice Address - Street 2:SUITE D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2771
Practice Address - Country:US
Practice Address - Phone:919-620-7900
Practice Address - Fax:919-479-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1958261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2450562BMedicare UPIN