Provider Demographics
NPI:1821313503
Name:NEUROLOGY AND SPINE CENTER
Entity Type:Organization
Organization Name:NEUROLOGY AND SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-949-9000
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33929-0313
Mailing Address - Country:US
Mailing Address - Phone:239-949-9000
Mailing Address - Fax:239-949-9020
Practice Address - Street 1:10201 ARCOS AVE STE 103
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9460
Practice Address - Country:US
Practice Address - Phone:239-949-9000
Practice Address - Fax:239-949-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF607AOtherMEDICARE PTAN