MEDICARE: SOUTHERN SPINE PARTNERS 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
1	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1417421819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN SPINE PARTNERS LLC

Provider Business Mailing Address
First Line	:	9521B RIVERSIDE PKWY # 338
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-7304
Country	:	US
Telephone Number	:	918-895-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	9521B RIVERSIDE PKWY # 338
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-7304
Country	:	US
Telephone Number	:	918-895-7680
Fax Number	:

Authorized Official
Title or Position	:	BILLING ASSOCIATE
Name	:	VALERIE SHEHAN
Credential	:
Telephone Number	:	918-895-7680

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	01/18/2019

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Directions to “SOUTHERN SPINE PARTNERS LLC ” Practice Location

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