Provider Demographics
NPI:1639339021
Name:SPINE INNOVATIONS, LLC
Entity Type:Organization
Organization Name:SPINE INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAZZARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-255-1580
Mailing Address - Street 1:11912 KANIS RD STE F8
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3771
Mailing Address - Country:US
Mailing Address - Phone:501-255-1580
Mailing Address - Fax:
Practice Address - Street 1:11912 KANIS RD STE F8
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3771
Practice Address - Country:US
Practice Address - Phone:501-255-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory