Provider Demographics
NPI:1700093879
Name:NEUROSURGERY & SPINE INC
Entity Type:Organization
Organization Name:NEUROSURGERY & SPINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PINGREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-261-8507
Mailing Address - Street 1:1220 E 3900 S STE 4E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1343
Mailing Address - Country:US
Mailing Address - Phone:801-261-8507
Mailing Address - Fax:801-261-8511
Practice Address - Street 1:1220 E 3900 S STE 4E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1343
Practice Address - Country:US
Practice Address - Phone:801-261-8507
Practice Address - Fax:801-261-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344599-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH63060Medicare UPIN