Provider Demographics
NPI:1801031703
Name:TOTAL SPINE SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:TOTAL SPINE SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-636-5311
Mailing Address - Street 1:1455 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-2410
Mailing Address - Country:US
Mailing Address - Phone:251-246-7333
Mailing Address - Fax:
Practice Address - Street 1:1455 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2410
Practice Address - Country:US
Practice Address - Phone:251-246-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty