Provider Demographics
NPI:1942268289
Name:PREMIER SPINE CARE, P.A.
Entity Type:Organization
Organization Name:PREMIER SPINE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-322-2700
Mailing Address - Street 1:PO BOX 26250
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-6250
Mailing Address - Country:US
Mailing Address - Phone:913-322-2700
Mailing Address - Fax:913-322-7890
Practice Address - Street 1:23351 PRAIRIE STAR PARKWAY
Practice Address - Street 2:BUILDING A STE 275
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227
Practice Address - Country:US
Practice Address - Phone:913-322-2700
Practice Address - Fax:913-322-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty