Provider Demographics
NPI:1629335294
Name:PREMIER SPINE CENTER,INC
Entity Type:Organization
Organization Name:PREMIER SPINE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EXARHOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-829-6317
Mailing Address - Street 1:2699 STIRLING RD
Mailing Address - Street 2:SUITE C-405
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6517
Mailing Address - Country:US
Mailing Address - Phone:954-966-9696
Mailing Address - Fax:954-987-9796
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE C-405
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-966-9696
Practice Address - Fax:954-987-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060513261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14097BMedicare UPIN