Provider Demographics
NPI:1386281475
Name:NORTHERN NEUROSURGERY AND SPINE PLC
Entity type:Organization
Organization Name:NORTHERN NEUROSURGERY AND SPINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:BROADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-356-7444
Mailing Address - Street 1:350 23RD AVE E STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7401
Mailing Address - Country:US
Mailing Address - Phone:701-356-7444
Mailing Address - Fax:855-453-4956
Practice Address - Street 1:350 23RD AVE E STE 102
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7401
Practice Address - Country:US
Practice Address - Phone:701-356-7444
Practice Address - Fax:855-453-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-08
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center