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General NPI Number Information
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NPI Number | 1497802060
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Entity Type | Organization
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Legal Business Name | SPINE SURGERY, LTD.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 2790 CLAY EDWARDS DR STE 630
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116
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Country | US
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Telephone | 816-471-6611
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Fax | 816-471-6192
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Provider Business Mailing Address
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Address Line | 2790 CLAY EDWARDS DR STE 630
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-3274
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Country | US
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Telephone | 816-471-6611
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Fax | 816-471-6192
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID K EBELKE
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Credential | M.D.
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Telephone | 816-471-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | R5J93
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License Number State | MO
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