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NPI Code Detail

MEDICARE: CENTER FOR NEUROSURGICAL AND SPINE DISORDERS, LLC

MEDICARE: CENTER FOR NEUROSURGICAL AND SPINE DISORDERS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207T00000XNeurological Surgery Physician021935LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184631210
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER FOR NEUROSURGICAL AND SPINE DISORDERS, LLC
Provider Business Mailing Address
First Line : PO BOX 1786
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70602-1786
Country : US
Telephone Number : 337-478-9653
Fax Number : 337-474-0988
Provider Business Practice Location Address
First Line : 1614 WOLF CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2348
Country : US
Telephone Number : 337-478-9653
Fax Number : 337-474-0988
Authorized Official
Title or Position : PRACTICE MANAGER
Name : DEE F HARLESS
Credential :
Telephone Number : 337-478-9653
Provider Enumeration Date : 08/02/2006
Last Update Date : 07/27/2010

Similar Medicare Providers

1407852288 — DEANNA FREDERICKS HARLESS ACNP
Practice Location Address:
1614 WOLF CIR
LAKE CHARLES, LA
70605-2348
Practice Phone: 337-478-9653
Practice Fax: 337-474-0988
1942206727 — DR. ERICH W WOLF JR. M.D, PH.D
Practice Location Address:
1614 WOLF CIR
LAKE CHARLES, LA
70605-2348
Practice Phone: 337-478-9653
Practice Fax: 337-474-0988
1750587838 — BRIAN CHRISTOPHER KELLEY D.O.
Practice Location Address:
1614 WOLF CIR
LAKE CHARLES, LA
70605-2348
Practice Phone: 337-478-9653
Practice Fax: 337-474-0988
1083875850 — DR. BRIDGET CATHERINE LOEHN M.D.
Practice Location Address:
1615 WOLF CIR
LAKE CHARLES, LA
70605-2348
Practice Phone: 337-419-1960
Practice Fax: 337-419-1961
1073842134 — TARA C BARNES APRN
Practice Location Address:
1614 WOLF CIR
LAKE CHARLES, LA
70605-2348
Practice Phone: 337-478-9653
Practice Fax: 337-474-0988
1982910014 — MRS. KASIE CARIN NIX ANP-C
Practice Location Address:
1614 WOLF CIR
LAKE CHARLES, LA
70605-2348
Practice Phone: 337-478-9653
Practice Fax:

Directions to “CENTER FOR NEUROSURGICAL AND SPINE DISORDERS, LLC ” Practice Location

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