MEDICARE: INSTITUTE FOR SPINE INC

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
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	35056000	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1336181163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR SPINE INC

Provider Business Mailing Address
First Line	:	7551 FREDLE DR
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9406
Country	:	US
Telephone Number	:	440-357-1502
Fax Number	:	440-357-1905

Provider Business Practice Location Address
First Line	:	7551 FREDLE DR
Second Line	:
City	:	CONCORD TWP
State	:	OH
Zip	:	44077-9406
Country	:	US
Telephone Number	:	440-357-1502
Fax Number	:	440-357-1905

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MACHELLE GIORDON
Credential	:
Telephone Number	:	330-723-2111

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	11/03/2010

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Directions to “INSTITUTE FOR SPINE INC ” Practice Location

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