Provider Demographics
NPI:1821327560
Name:JUNEAU SPINE AND PAIN CENTER LLC
Entity Type:Organization
Organization Name:JUNEAU SPINE AND PAIN CENTER LLC
Other - Org Name:SOUTHEAST ALASKA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-723-9885
Mailing Address - Street 1:3200 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7808
Mailing Address - Country:US
Mailing Address - Phone:907-523-5962
Mailing Address - Fax:800-766-1962
Practice Address - Street 1:3200 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7808
Practice Address - Country:US
Practice Address - Phone:907-523-5962
Practice Address - Fax:800-766-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK360285261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical