Provider Demographics
NPI:1821113416
Name:SPINAL CARE MANAGEMENT LP
Entity Type:Organization
Organization Name:SPINAL CARE MANAGEMENT LP
Other - Org Name:PHILADELPHIA SPINAL CARE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA MS
Authorized Official - Phone:215-462-6600
Mailing Address - Street 1:2410 S BROAD ST
Mailing Address - Street 2:3RD FLR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4418
Mailing Address - Country:US
Mailing Address - Phone:215-462-6600
Mailing Address - Fax:215-462-2650
Practice Address - Street 1:2410 S BROAD ST
Practice Address - Street 2:3RD FLR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-4418
Practice Address - Country:US
Practice Address - Phone:215-462-6600
Practice Address - Fax:215-462-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherFACILITY TAX ID