Provider Demographics
NPI:1659827095
Name:NEUROSPINE MONITOR, PLLC
Entity Type:Organization
Organization Name:NEUROSPINE MONITOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-269-3875
Mailing Address - Street 1:14250 BEADLE LAKE RD
Mailing Address - Street 2:160
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-7200
Mailing Address - Country:US
Mailing Address - Phone:214-269-3875
Mailing Address - Fax:903-328-6568
Practice Address - Street 1:14250 BEADLE LAKE RD
Practice Address - Street 2:160
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-7200
Practice Address - Country:US
Practice Address - Phone:214-269-3875
Practice Address - Fax:903-328-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty