Healthcare Provider Details

I. General information

NPI: 1518373810
Provider Name (Legal Business Name): LASER SPINE SURGERY CENTER OF CINCINNATI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 EDEN PARK DR
CINCINNATI OH
45202-6031
US

IV. Provider business mailing address

5332 AVION PARK DR
TAMPA FL
33607-1412
US

V. Phone/Fax

Practice location:
  • Phone: 513-906-6956
  • Fax: 484-253-1790
Mailing address:
  • Phone: 813-682-2944
  • Fax: 484-253-1790

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: DR. MICHAEL W PERRY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 813-289-9613