Provider Demographics
NPI:1841235207
Name:NEUROSURGICAL SPINE CENTER. INC
Entity Type:Organization
Organization Name:NEUROSURGICAL SPINE CENTER. INC
Other - Org Name:SPINE CENTER OF EXCELLENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIANNAKOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-861-2332
Mailing Address - Street 1:PO BOX 5849
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5849
Mailing Address - Country:US
Mailing Address - Phone:727-861-2332
Mailing Address - Fax:727-861-3217
Practice Address - Street 1:11906 OAK TRAIL WAY
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1037
Practice Address - Country:US
Practice Address - Phone:727-861-2332
Practice Address - Fax:727-861-3217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROSURGICAL SPINE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF81466Medicare UPIN
FL25324YMedicare ID - Type Unspecified