Provider Demographics
NPI:1891207569
Name:LASER SPINE INSTITUTE LL SOLE MBR
Entity Type:Organization
Organization Name:LASER SPINE INSTITUTE LL SOLE MBR
Other - Org Name:SPINE DME SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-289-9613
Mailing Address - Street 1:5332 AVION PARK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1412
Mailing Address - Country:US
Mailing Address - Phone:813-392-7604
Mailing Address - Fax:484-253-1790
Practice Address - Street 1:4727 GAILLARDIA PKWY STE 140
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-1927
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:484-253-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical