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General NPI Number Information
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NPI Number | 1982158176
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Entity Type | Organization
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Legal Business Name | LAKE SPINE CONSULTANTS LLC
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 353 NEW SHACKLE ISLAND RD SUITE 141C
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2379
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Country | US
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Telephone | 214-378-4656
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674074
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City | DALLAS
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State | TX
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Zip | 75267-4074
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Country | US
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Telephone | 214-378-4656
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Fax |
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Authorized Official
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Title or Position | RCM
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Name | HOLLIE SEAGO
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Credential |
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Telephone | 214-378-4656
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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 | 43046
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License Number State | TN
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