Provider Demographics
NPI:1811383896
Name:NC NEUROSURGERY AND SPINE CLINIC PLLC
Entity Type:Organization
Organization Name:NC NEUROSURGERY AND SPINE CLINIC PLLC
Other - Org Name:JOHN R SPITALIERI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPITALIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-489-1140
Mailing Address - Street 1:2109 VALLEYGATE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3682
Mailing Address - Country:US
Mailing Address - Phone:910-489-1140
Mailing Address - Fax:
Practice Address - Street 1:2109 VALLEYGATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3682
Practice Address - Country:US
Practice Address - Phone:910-489-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty