Provider Demographics
NPI:1609000546
Name:SPINE MED - CENTER
Entity Type:Organization
Organization Name:SPINE MED - CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ESKANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-865-4731
Mailing Address - Street 1:9344 THREE RIVERS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4268
Mailing Address - Country:US
Mailing Address - Phone:228-865-4731
Mailing Address - Fax:
Practice Address - Street 1:9344 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4268
Practice Address - Country:US
Practice Address - Phone:228-865-4731
Practice Address - Fax:228-863-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18381174400000X
MS17733174400000X
MS07091174400000X
MS12692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty