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General NPI Number Information
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NPI Number | 1902836133
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Entity Type | Organization
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Legal Business Name | MIDWEST SPINE & BRAIN INSTITUTE, L.L.C.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 1950 NORTHWESTERN AVE S STE 102
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City | STILLWATER
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State | MN
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Zip | 55082-7615
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Country | US
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Telephone | 651-430-3800
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Fax | 651-430-3827
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Provider Business Mailing Address
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Address Line | 1950 NORTHWESTERN AVE S STE 102
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City | STILLWATER
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State | MN
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Zip | 55082-7615
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Country | US
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Telephone | 651-430-3800
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Fax | 651-430-3827
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHARI OHLAND
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Credential | MHA, CMPE
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Telephone | 651-430-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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License Number State |
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