Provider Demographics
NPI:1285050211
Name:MAI SPINE CENTER P.A.
Entity type:Organization
Organization Name:MAI SPINE CENTER P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-797-3866
Mailing Address - Street 1:485 ARUNDEL ST # 102
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1931
Mailing Address - Country:US
Mailing Address - Phone:651-797-3866
Mailing Address - Fax:651-207-5395
Practice Address - Street 1:485 ARUNDEL ST # 102
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1931
Practice Address - Country:US
Practice Address - Phone:651-797-3866
Practice Address - Fax:651-207-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNC593261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)