Provider Demographics
NPI:1619747284
Name:SPINE CAPITAL LLC
Entity Type:Organization
Organization Name:SPINE CAPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MAWUNYO
Authorized Official - Last Name:KOFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-999-5248
Mailing Address - Street 1:1757 E BASELINE RD STE 131
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1534
Mailing Address - Country:US
Mailing Address - Phone:480-999-5248
Mailing Address - Fax:480-999-5285
Practice Address - Street 1:1757 E BASELINE RD STE 131
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1534
Practice Address - Country:US
Practice Address - Phone:480-999-5248
Practice Address - Fax:480-999-5285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies