Provider Demographics
NPI:1265524631
Name:NEURO ORTHO SPINE CLINIC LLC
Entity type:Organization
Organization Name:NEURO ORTHO SPINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRIBIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-454-8208
Mailing Address - Street 1:2920 KINGMAN STREET
Mailing Address - Street 2:SUITE 120
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-454-8308
Mailing Address - Fax:504-454-8326
Practice Address - Street 1:2920 KINGMAN STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-454-8308
Practice Address - Fax:504-454-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09098R207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CD98Medicare ID - Type Unspecified