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1912083957 NPI number — INTERNATIONAL SPINE SURGERY & PAIN INSTITURE PA

NPI Number: 1912083957
Health Care Provider/Practitioner: INTERNATIONAL SPINE SURGERY & PAIN INSTITURE PA

Information about “1912083957” NPI (INTERNATIONAL SPINE SURGERY & PAIN INSTITURE PA) exists in 1912083957 in HTML format HTML  |  1912083957 in plain Text format TXT  |  1912083957 in PDF (Portable Document Format) PDF  |  1912083957 in an XML format XML  formats.

NPI Number : 1912083957 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912083957",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "INTERNATIONAL SPINE SURGERY & PAIN INSTITURE PA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1513 MARKET PLACE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JONESBORO",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-931-0655",
    "MailingAddressFaxNumber": "870-931-0665",
    "FirstLinePracticeLocationAddress": "1513 MARKET PLACE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JONESBORO",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72401",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "870-931-0655",
    "PracticeLocationAddressFaxNumber": "870-931-0665",
    "EnumerationDate": "10/31/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EUBANKS",
    "AuthorizedOfficialFirstName": "KENNETH",
    "AuthorizedOfficialMiddleName": "DEWAYNE",
    "AuthorizedOfficialTitle": "DOCTOR/OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "870-931-0655",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207T00000X",
          "TaxonomyName": "Neurological Surgery Physician",
          "LicenseNumber": "E2241",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": "1177",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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