Provider Demographics
NPI:1104586916
Name:PERFORMANCE SPINE AND BRAIN, LLC
Entity type:Organization
Organization Name:PERFORMANCE SPINE AND BRAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BIRINYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-238-0827
Mailing Address - Street 1:PO BOX 11758
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-1758
Mailing Address - Country:US
Mailing Address - Phone:800-238-0827
Mailing Address - Fax:318-219-5221
Practice Address - Street 1:233 PECAN PARK AVE STE D
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3362
Practice Address - Country:US
Practice Address - Phone:800-238-0827
Practice Address - Fax:318-219-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2483978Medicaid