Provider Demographics
NPI:1285720656
Name:THE INSTITUTE OF BRAIN AND SPINE SURGERY
Entity type:Organization
Organization Name:THE INSTITUTE OF BRAIN AND SPINE SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-0965
Mailing Address - Street 1:21320 HAWTHORNE BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5503
Mailing Address - Country:US
Mailing Address - Phone:310-540-0965
Mailing Address - Fax:310-540-6937
Practice Address - Street 1:21350 HAWTHORNE BLVD STE 176
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5635
Practice Address - Country:US
Practice Address - Phone:310-540-0965
Practice Address - Fax:310-540-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG327300Medicaid
CAOOA341240Medicaid
CAOOG242050Medicaid
CAW14194AMedicare ID - Type UnspecifiedMEDICARE NUMBER
CAW14194BMedicare ID - Type UnspecifiedMEDICARE NUMBER
CAW14194Medicare ID - Type UnspecifiedMEDICARE NUMBER
CAOOA341240Medicaid
CAA45266Medicare UPIN
CAOOG242050Medicaid