Healthcare Provider Details

I. General information

NPI: 1124263660
Provider Name (Legal Business Name): BRAIN AND SPINE NEUROSUGERY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD SUITE 102
STUART FL
34994-4512
US

IV. Provider business mailing address

1050 SE MONTEREY RD SUITE 102
STUART FL
34994-4512
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-9700
  • Fax:
Mailing address:
  • Phone: 772-220-9700
  • Fax: 772-219-8196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YONAS ZEGEYE
Title or Position: PRESIDENT
Credential: MD
Phone: 772-220-9700