Provider Demographics
NPI:1417421819
Name:SOUTHERN SPINE PARTNERS LLC
Entity type:Organization
Organization Name:SOUTHERN SPINE PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-895-7680
Mailing Address - Street 1:9521B RIVERSIDE PKWY # 338
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7304
Mailing Address - Country:US
Mailing Address - Phone:918-895-7680
Mailing Address - Fax:
Practice Address - Street 1:9521B RIVERSIDE PKWY # 338
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7304
Practice Address - Country:US
Practice Address - Phone:918-895-7680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty