Provider Demographics
NPI:1255621066
Name:BRUCE D SPINZIG INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:BRUCE D SPINZIG INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINZIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-207-5945
Mailing Address - Street 1:1754 MADISON STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2924
Mailing Address - Country:US
Mailing Address - Phone:931-647-6770
Mailing Address - Fax:931-647-6813
Practice Address - Street 1:1754 MADISON STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2924
Practice Address - Country:US
Practice Address - Phone:931-647-6770
Practice Address - Fax:931-647-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002310Medicaid