Provider Demographics
NPI:1154602183
Name:SPINE SURGERY PROVIDERS LLC
Entity type:Organization
Organization Name:SPINE SURGERY PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-550-5300
Mailing Address - Street 1:10455 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 109-340
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2213
Mailing Address - Country:US
Mailing Address - Phone:214-550-5300
Mailing Address - Fax:
Practice Address - Street 1:10455 N CENTRAL EXPY
Practice Address - Street 2:SUITE 109-340
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2213
Practice Address - Country:US
Practice Address - Phone:214-550-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty