Provider Demographics
NPI:1629369210
Name:SPINE INSTITUTE OF LOUISIANA LLC
Entity Type:Organization
Organization Name:SPINE INSTITUTE OF LOUISIANA LLC
Other - Org Name:SPINE INSTITUTE OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-629-5555
Mailing Address - Street 1:1500 LINE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4639
Mailing Address - Country:US
Mailing Address - Phone:318-629-5555
Mailing Address - Fax:318-629-5556
Practice Address - Street 1:1500 LINE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4639
Practice Address - Country:US
Practice Address - Phone:318-629-5555
Practice Address - Fax:318-629-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty