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NPI Code Detail

MEDICARE: SOUTHERN SPINE SERVICES, LLC

MEDICARE: SOUTHERN SPINE SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204R00000XElectrodiagnostic Medicine Physician

General Provider Information

NPI Number : 1760910053
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN SPINE SERVICES, LLC
Provider Business Mailing Address
First Line : 5729 LEBANON RD, STE 144-206
Second Line :
City : FRISCO
State : TX
Zip : 75034-7260
Country : US
Telephone Number : 918-895-7680
Fax Number : 918-236-4646
Provider Business Practice Location Address
First Line : 9521 B RIVERSIDE PARKWAY #338
Second Line :
City : TULSA
State : OK
Zip : 74137-7422
Country : US
Telephone Number : 918-895-7680
Fax Number : 918-236-4646
Authorized Official
Title or Position : BILLING
Name : CRISTI VINSON
Credential :
Telephone Number : 918-895-7680
Provider Enumeration Date : 05/31/2017
Last Update Date : 10/15/2018

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Directions to “SOUTHERN SPINE SERVICES, LLC ” Practice Location

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