Provider Demographics
NPI:1215478987
Name:NEUROSCIENCE AND SPINE ASSOCIATES PL
Entity type:Organization
Organization Name:NEUROSCIENCE AND SPINE ASSOCIATES PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-449-3072
Mailing Address - Street 1:3451 PINE RIDGE ROAD BUILDING 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:239-449-3072
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:681 GOODLETTE ROAD N.
Practice Address - Street 2:SUITE 220
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5458
Practice Address - Country:US
Practice Address - Phone:239-263-4511
Practice Address - Fax:239-263-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty