Provider Demographics
NPI:1336181163
Name:INSTITUTE FOR SPINE INC
Entity Type:Organization
Organization Name:INSTITUTE FOR SPINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-723-2111
Mailing Address - Street 1:7551 FREDLE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9406
Mailing Address - Country:US
Mailing Address - Phone:440-357-1502
Mailing Address - Fax:440-357-1905
Practice Address - Street 1:7551 FREDLE DR
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9406
Practice Address - Country:US
Practice Address - Phone:440-357-1502
Practice Address - Fax:440-357-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056000207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0880480Medicaid
OH5766740001Medicare NSC
OH0880480Medicaid