Provider Demographics
NPI:1639789852
Name:DELAWARE BRAIN AND SPINE CENTER OF EXCELLENCE, LLC
Entity Type:Organization
Organization Name:DELAWARE BRAIN AND SPINE CENTER OF EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-922-3806
Mailing Address - Street 1:602 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-9514
Mailing Address - Country:US
Mailing Address - Phone:302-900-1507
Mailing Address - Fax:
Practice Address - Street 1:200 BANNING ST STE 200
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3487
Practice Address - Country:US
Practice Address - Phone:302-922-3806
Practice Address - Fax:302-450-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty