Provider Demographics
NPI:1831142421
Name:SPINE AND ORTHOPAEDIC SURGERY CENTER LTD
Entity Type:Organization
Organization Name:SPINE AND ORTHOPAEDIC SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-296-3900
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE 611
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-296-3900
Mailing Address - Fax:773-296-3900
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 611
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-3900
Practice Address - Fax:773-296-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055515174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055515Medicaid
IL036055515Medicaid
ILL66495Medicare UPIN