Provider Demographics
NPI:1932752243
Name:REGIONAL BRAIN & SPINE LLC
Entity Type:Organization
Organization Name:REGIONAL BRAIN & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-332-7746
Mailing Address - Street 1:1723 BROADWAY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4556
Mailing Address - Country:US
Mailing Address - Phone:573-332-7746
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1617 EAST MALONE
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5021
Practice Address - Country:US
Practice Address - Phone:573-332-7746
Practice Address - Fax:573-339-9709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL BRAIN & SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty