Provider Demographics
NPI:1508432048
Name:SPINE SURGERY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:SPINE SURGERY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-242-4345
Mailing Address - Street 1:14100 PARKWAY COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-6104
Mailing Address - Country:US
Mailing Address - Phone:405-242-4345
Mailing Address - Fax:405-242-4333
Practice Address - Street 1:14100 PARKWAY COMMONS DR STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6104
Practice Address - Country:US
Practice Address - Phone:405-242-4345
Practice Address - Fax:405-242-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty