Provider Demographics
NPI:1912771940
Name:HA SPINE SURGERY PC.
Entity Type:Organization
Organization Name:HA SPINE SURGERY PC.
Other - Org Name:HA SPINE SURGERY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-322-1794
Mailing Address - Street 1:2239 NE DOCTORS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7185
Mailing Address - Country:US
Mailing Address - Phone:541-322-1794
Mailing Address - Fax:541-749-2126
Practice Address - Street 1:2239 NE DOCTORS DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7185
Practice Address - Country:US
Practice Address - Phone:541-322-1794
Practice Address - Fax:541-749-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty