Provider Demographics
NPI:1982063137
Name:BRAIN AND SPINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:BRAIN AND SPINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:ALVERNIA-SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-227-4675
Mailing Address - Street 1:2600 BELOIT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2515
Mailing Address - Country:US
Mailing Address - Phone:318-227-4675
Mailing Address - Fax:855-230-1466
Practice Address - Street 1:2408 DUVAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2986
Practice Address - Country:US
Practice Address - Phone:318-227-4675
Practice Address - Fax:855-230-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty