Provider Demographics
NPI:1619520616
Name:PREMIER NEUROSPINE INSTITUTE, LLC
Entity Type:Organization
Organization Name:PREMIER NEUROSPINE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOEBBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-605-1770
Mailing Address - Street 1:5800 49TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2100
Mailing Address - Country:US
Mailing Address - Phone:727-605-1770
Mailing Address - Fax:
Practice Address - Street 1:5800 49TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2100
Practice Address - Country:US
Practice Address - Phone:727-605-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty