Provider Demographics
NPI:1740352947
Name:THE SPINE INSTITUTE PC
Entity type:Organization
Organization Name:THE SPINE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-573-7733
Mailing Address - Street 1:13431 OLD MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1498
Mailing Address - Country:US
Mailing Address - Phone:317-573-7733
Mailing Address - Fax:317-573-7739
Practice Address - Street 1:13431 OLD MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1498
Practice Address - Country:US
Practice Address - Phone:317-573-7733
Practice Address - Fax:317-573-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100118910AMedicaid
IN1285340001Medicare NSC
IN313400Medicare PIN
INCD7007Medicare PIN