Provider Demographics
NPI:1609923366
Name:SPINE & SCOLIOSIS SURGERY, INC.
Entity Type:Organization
Organization Name:SPINE & SCOLIOSIS SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-471-6611
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 630
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3274
Mailing Address - Country:US
Mailing Address - Phone:816-471-6611
Mailing Address - Fax:816-471-6192
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 630
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-471-6611
Practice Address - Fax:816-471-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5717207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4571391OtherAETNA
200018411OtherRAILROAD MEDICARE
09-00221OtherUNITED HEALTHCARE
012289011OtherBCBS OF KC
012289011OtherBCBS OF KC
3920000Medicare ID - Type Unspecified
4571391OtherAETNA