Provider Demographics
NPI:1912964032
Name:SPINE AND BRAIN NEUROSURGERY CENTER
Entity type:Organization
Organization Name:SPINE AND BRAIN NEUROSURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-375-4567
Mailing Address - Street 1:601 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1496
Mailing Address - Country:US
Mailing Address - Phone:610-375-4567
Mailing Address - Fax:610-685-8801
Practice Address - Street 1:601 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1443
Practice Address - Country:US
Practice Address - Phone:610-375-4567
Practice Address - Fax:610-685-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty