Provider Demographics
NPI:1750995361
Name:ADVANCED SPINAL RECONSTRUCTION PLLC
Entity type:Organization
Organization Name:ADVANCED SPINAL RECONSTRUCTION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOREARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-421-0243
Mailing Address - Street 1:1221 BOWERS ST UNIT 2710
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-7106
Mailing Address - Country:US
Mailing Address - Phone:248-228-0054
Mailing Address - Fax:
Practice Address - Street 1:972 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1223
Practice Address - Country:US
Practice Address - Phone:248-228-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty