Provider Demographics
NPI:1316324403
Name:INDIANA SPINE HOSPITAL, LLC
Entity type:Organization
Organization Name:INDIANA SPINE HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:SASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-715-4863
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-715-4863
Mailing Address - Fax:317-795-2047
Practice Address - Street 1:13219 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5480
Practice Address - Country:US
Practice Address - Phone:317-795-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No282N00000XHospitalsGeneral Acute Care Hospital