Provider Demographics
NPI:1699045674
Name:MD SPINE SOLUTIONS LLC
Entity Type:Organization
Organization Name:MD SPINE SOLUTIONS LLC
Other - Org Name:MD LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-391-5221
Mailing Address - Street 1:10715 DOUBLE R BLVD
Mailing Address - Street 2:#102
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8975
Mailing Address - Country:US
Mailing Address - Phone:775-391-5221
Mailing Address - Fax:
Practice Address - Street 1:10715 DOUBLE R BLVD
Practice Address - Street 2:#102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8975
Practice Address - Country:US
Practice Address - Phone:775-391-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MD SPINE SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory