Provider Demographics
NPI:1992753289
Name:REGIONAL BRAIN & SPINE LLC
Entity type:Organization
Organization Name:REGIONAL BRAIN & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-332-7746
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1329
Mailing Address - Country:US
Mailing Address - Phone:573-332-7746
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1723 BROADWAY
Practice Address - Street 2:SUITE 410
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-332-7746
Practice Address - Fax:573-339-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505320101Medicaid
MO5427850001Medicare NSC
MO000014502Medicare ID - Type Unspecified