Provider Demographics
NPI:1881081552
Name:AAPOLO SPINE AND PAIN MANAGEMENT CENTER
Entity type:Organization
Organization Name:AAPOLO SPINE AND PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:NETTEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-573-6656
Mailing Address - Street 1:220 S NORTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3200
Mailing Address - Country:US
Mailing Address - Phone:765-573-6656
Mailing Address - Fax:765-573-6658
Practice Address - Street 1:4215 N 210 E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-6634
Practice Address - Country:US
Practice Address - Phone:765-664-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2421Medicare PIN