Provider Demographics
NPI:1902410368
Name:INSPIRED SPINE SURGCENTER LLC
Entity Type:Organization
Organization Name:INSPIRED SPINE SURGCENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-405-9760
Mailing Address - Street 1:1601 HIGHWAY 13 E STE 211
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5105
Mailing Address - Country:US
Mailing Address - Phone:952-402-9760
Mailing Address - Fax:855-430-6952
Practice Address - Street 1:7400 FRANCE AVE S STE 102
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4738
Practice Address - Country:US
Practice Address - Phone:952-405-9760
Practice Address - Fax:855-430-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical