Healthcare Provider Details

I. General information

NPI: 1255806048
Provider Name (Legal Business Name): GBS SPINAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 CONNECTICUT DR
CROWN POINT IN
46307-7486
US

IV. Provider business mailing address

11750 KATY FWY STE 1100
HOUSTON TX
77079-1257
US

V. Phone/Fax

Practice location:
  • Phone: 574-314-5023
  • Fax: 609-925-9007
Mailing address:
  • Phone: 574-204-2859
  • Fax: 609-925-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRAN PEDANO
Title or Position: RCM DIRECTOR
Credential:
Phone: 574-204-2859