Provider Demographics
NPI:1316971393
Name:SPINE INSTITUTE PSC
Entity type:Organization
Organization Name:SPINE INSTITUTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:502-584-8002
Mailing Address - Street 1:210 E GRAY ST
Mailing Address - Street 2:# 900
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-584-7525
Mailing Address - Fax:502-589-0849
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:# 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-589-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCM8616OtherMEDICARE RAILROAD
IN100020240AMedicaid
KY65917270Medicaid
163722400OtherUS DEPT OF LABOR
KY2433673000OtherPASSPORT ADVANTAGE
KY36123OtherCIGNA
KY1054516OtherPASSPORT
KY36123OtherCIGNA
KYCM8616OtherMEDICARE RAILROAD
163722400OtherUS DEPT OF LABOR
KY1054516OtherPASSPORT
KY36123OtherCIGNA