Healthcare Provider Details

I. General information

NPI: 1669805677
Provider Name (Legal Business Name): SPINE AND BRAIN NEUROSURGICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3256 LOCH NESS DR
LEXINGTON KY
40517-1239
US

IV. Provider business mailing address

3256 LOCH NESS DR
LEXINGTON KY
40517-1239
US

V. Phone/Fax

Practice location:
  • Phone: 859-971-0014
  • Fax: 859-971-0074
Mailing address:
  • Phone: 859-971-0014
  • Fax: 859-971-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN W. GILBERT
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 859-971-0014