Provider Demographics
NPI:1902368483
Name:SUBACH SPINAL SOLUTIONS
Entity Type:Organization
Organization Name:SUBACH SPINAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:703-981-8205
Mailing Address - Street 1:1635 N GEORGE MASON DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3679
Mailing Address - Country:US
Mailing Address - Phone:877-782-2241
Mailing Address - Fax:
Practice Address - Street 1:1635 N GEORGE MASON DR STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3679
Practice Address - Country:US
Practice Address - Phone:877-782-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty