Healthcare Provider Details

I. General information

NPI: 1710088463
Provider Name (Legal Business Name): SPINE SPECALITY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE SUITE 400
MEMPHIS TN
38119-5202
US

IV. Provider business mailing address

6005 PARK AVE SUITE 400
MEMPHIS TN
38119-5202
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-9500
  • Fax:
Mailing address:
  • Phone: 901-767-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number1772
License Number StateTN

VIII. Authorized Official

Name: DOUGLAS A LINVILLE
Title or Position: OWNER
Credential: MD
Phone: 901-767-9500