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General NPI Number Information
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NPI Number | 1578685368
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Entity Type | Organization
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Legal Business Name | NEUROSURGERY SPINE & PAIN ASSOC PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 3S220 WARREN AVE
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City | WARRENVILLE
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State | IL
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Zip | 60555-2914
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Country | US
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Telephone | 630-393-2222
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Fax | 630-393-2221
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Provider Business Mailing Address
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Address Line | 3S220 WARREN AVE
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City | WARRENVILLE
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State | IL
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Zip | 60555-2914
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Country | US
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Telephone | 630-393-2222
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Fax | 630-393-2221
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Authorized Official
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Title or Position | BUSINESS MANAGER / TREASURER
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Name | ALLISON HILL ROSS
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Credential | MBA
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Telephone | 630-452-1467
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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 | 036072169
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License Number State | IL
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