Provider Demographics
NPI:1639229503
Name:AMERICAN SPINE INC
Entity Type:Organization
Organization Name:AMERICAN SPINE INC
Other - Org Name:AMERICAN SPINE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:KORFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-656-0302
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:WA
Mailing Address - Zip Code:98925-0430
Mailing Address - Country:US
Mailing Address - Phone:509-656-0302
Mailing Address - Fax:509-656-0299
Practice Address - Street 1:4682 NELSON SIDING RD
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-8819
Practice Address - Country:US
Practice Address - Phone:509-656-0302
Practice Address - Fax:509-656-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies