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General NPI Number Information
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NPI Number | 1124025333
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Entity Type | Organization
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Legal Business Name | SPINESOURCE AMERICA, L.L.C
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 354 WALLER AVE STE. 110
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City | LEXINGTON
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State | KY
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Zip | 40504-2928
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Country | US
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Telephone | 859-260-8576
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Fax | 859-201-1088
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Provider Business Mailing Address
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Address Line | 354 WALLER AVE STE. 102
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City | LEXINGTON
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State | KY
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Zip | 40504-2916
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Country | US
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Telephone | 859-260-8576
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Fax | 859-201-1088
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. JIM M CLIFTON
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Credential |
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Telephone | 859-260-8576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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