Provider Demographics
NPI:1700319175
Name:ORTHOPEDIC & SPINE SURGERY CENTER
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-239-8163
Mailing Address - Street 1:1507 LINWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5818
Mailing Address - Country:US
Mailing Address - Phone:870-239-8164
Mailing Address - Fax:870-239-8105
Practice Address - Street 1:1507 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:815-993-6699
Practice Address - Fax:870-239-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical