Healthcare Provider Details

I. General information

NPI: 1598246282
Provider Name (Legal Business Name): MULTIVERSE SURGICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SPRING ST
JEFFERSONVILLE IN
47130-3704
US

IV. Provider business mailing address

1220 SPRING ST
JEFFERSONVILLE IN
47130-3704
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LOU ROLAND
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 336-623-4545