Provider Demographics
NPI:1740348143
Name:SILVER STATE SPINECARE FORREST BURKE MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:SILVER STATE SPINECARE FORREST BURKE MD A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-331-2600
Mailing Address - Street 1:1055 ROBERTA LN
Mailing Address - Street 2:103
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1893
Mailing Address - Country:US
Mailing Address - Phone:775-331-2600
Mailing Address - Fax:775-331-2605
Practice Address - Street 1:1055 ROBERTA LN
Practice Address - Street 2:103
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1893
Practice Address - Country:US
Practice Address - Phone:775-331-2600
Practice Address - Fax:775-331-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8968208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG41736Medicare UPIN
NVV101676Medicare PIN
NV101677Medicare ID - Type Unspecified
NVV101677Medicare PIN