Provider Demographics
NPI:1518373810
Name:LASER SPINE SURGERY CENTER OF CINCINNATI
Entity Type:Organization
Organization Name:LASER SPINE SURGERY CENTER OF CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-289-9613
Mailing Address - Street 1:5332 AVION PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1412
Mailing Address - Country:US
Mailing Address - Phone:813-682-2944
Mailing Address - Fax:484-253-1790
Practice Address - Street 1:644 EDEN PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6031
Practice Address - Country:US
Practice Address - Phone:513-906-6956
Practice Address - Fax:484-253-1790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LSI HOLDCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-08
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical