Healthcare Provider Details

I. General information

NPI: 1407836315
Provider Name (Legal Business Name): SPINE CARE DELAWARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 OGLETOWN - STANTON RD
NEWARK DE
19713
US

IV. Provider business mailing address

4102 OGLETOWN - STANTON RD
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-894-1900
  • Fax: 302-894-0264
Mailing address:
  • Phone: 302-894-1900
  • Fax: 302-737-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1999209751
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BONNIE O'CONNOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 302-894-1900