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General NPI Number Information
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NPI Number | 1790876431
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Entity Type | Organization
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Legal Business Name | MAIN LINE SPINE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 700 S HENDERSON RD STE 335
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406
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Country | US
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Telephone | 610-337-2828
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Fax | 610-337-2955
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Provider Business Mailing Address
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Address Line | 700 S HENDERSON RD STE 335
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4206
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Country | US
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Telephone | 610-337-2828
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Fax | 610-337-2955
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | KATHLENE NEGVESKY
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Credential |
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Telephone | 610-337-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1787
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License Number State | PA
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