Provider Demographics
NPI:1710088463
Name:SPINE SPECALITY CENTER PLLC
Entity Type:Organization
Organization Name:SPINE SPECALITY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-767-9500
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-767-9500
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-767-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1772364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EXEMPTMedicare UPIN
TN3726011Medicare ID - Type UnspecifiedMEDICARE GROUP