Provider Demographics
NPI:1760728133
Name:SPINE CARE OF METAIRIE LLC
Entity Type:Organization
Organization Name:SPINE CARE OF METAIRIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:504-828-0880
Mailing Address - Street 1:3017 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6046
Mailing Address - Country:US
Mailing Address - Phone:504-828-0880
Mailing Address - Fax:504-828-3008
Practice Address - Street 1:3017 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6046
Practice Address - Country:US
Practice Address - Phone:504-828-0880
Practice Address - Fax:504-828-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty