Provider Demographics
NPI:1669139259
Name:BRAIN AND SPINE SPECIALISTS, INC
Entity type:Organization
Organization Name:BRAIN AND SPINE SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMESFAHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-920-1688
Mailing Address - Street 1:1859 CHINAR TREE DR
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-2524
Mailing Address - Country:US
Mailing Address - Phone:307-920-1688
Mailing Address - Fax:
Practice Address - Street 1:1859 CHINAR TREE DR
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-2524
Practice Address - Country:US
Practice Address - Phone:307-920-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center