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General NPI Number Information
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NPI Number | 1265524631
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Entity Type | Organization
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Legal Business Name | NEURO ORTHO SPINE CLINIC LLC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2920 KINGMAN STREET SUITE 120
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City | METAIRIE
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State | LA
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Zip | 70006
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Country | US
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Telephone | 504-454-8308
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Fax | 504-454-8326
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Provider Business Mailing Address
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Address Line | 2920 KINGMAN STREET SUITE 120
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City | METAIRIE
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State | LA
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Zip | 70006
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Country | US
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Telephone | 504-454-8308
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Fax | 504-454-8326
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Authorized Official
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Title or Position | OWNER
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Name | STEFAN G PRIBIL
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Credential | MD
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Telephone | 504-454-8208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 09098R
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License Number State | LA
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