Provider Demographics
NPI:1629853312
Name:LASH ORTHOSPINE AND SPORTS LLC
Entity Type:Organization
Organization Name:LASH ORTHOSPINE AND SPORTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-262-5758
Mailing Address - Street 1:2800 ROSS CLARK CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-9917
Mailing Address - Country:US
Mailing Address - Phone:334-239-0063
Mailing Address - Fax:334-239-4493
Practice Address - Street 1:2800 ROSS CLARK CIR STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-9917
Practice Address - Country:US
Practice Address - Phone:480-262-5758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty