Provider Demographics
NPI:1508165671
Name:ADVANCED INTERVENTIONAL SPINE AND SURGERY PC
Entity Type:Organization
Organization Name:ADVANCED INTERVENTIONAL SPINE AND SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-400-6932
Mailing Address - Street 1:6382 E MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9327
Mailing Address - Country:US
Mailing Address - Phone:989-400-6932
Mailing Address - Fax:
Practice Address - Street 1:6382 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9327
Practice Address - Country:US
Practice Address - Phone:989-400-6932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092952261QM2500X, 261QP2300X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain