Provider Demographics
NPI:1801140439
Name:MIDWEST NEUROSURGERY & SPINE SPECIALISTS, PC
Entity type:Organization
Organization Name:MIDWEST NEUROSURGERY & SPINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-474-9809
Mailing Address - Street 1:3S220 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2914
Mailing Address - Country:US
Mailing Address - Phone:630-393-2222
Mailing Address - Fax:630-393-2221
Practice Address - Street 1:3S220 WARREN AVE
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2914
Practice Address - Country:US
Practice Address - Phone:630-393-2222
Practice Address - Fax:630-393-2221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST NEUROSURGERY & SPINE SPECIALISTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site