Provider Demographics
NPI:1962874925
Name:NEUROSPINE SPECIALISTS
Entity type:Organization
Organization Name:NEUROSPINE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HIGHSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-553-7615
Mailing Address - Street 1:9313 MEDICAL PLAZA DR
Mailing Address - Street 2:STE 305
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9155
Mailing Address - Country:US
Mailing Address - Phone:843-553-7615
Mailing Address - Fax:843-553-1008
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:STE 305
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-553-7615
Practice Address - Fax:843-553-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29442207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty