Provider Demographics
NPI:1699705640
Name:RECONSTRUCTIVE SPINAL SURGERY & ORTHOPEDIC SURGERY PC
Entity type:Organization
Organization Name:RECONSTRUCTIVE SPINAL SURGERY & ORTHOPEDIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:402-371-0839
Mailing Address - Street 1:109 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3261
Mailing Address - Country:US
Mailing Address - Phone:402-371-0839
Mailing Address - Fax:402-371-0840
Practice Address - Street 1:109 N 29TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3261
Practice Address - Country:US
Practice Address - Phone:402-371-0839
Practice Address - Fax:402-371-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025272500Medicaid
NEDD6021OtherRAILROAD MEDICARE
NEDD6021OtherRAILROAD MEDICARE