# SPINE MEDICAL CENTER,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720207749
- **Authorized official:** DR. JOEL BERMAN BURWELL D.O. (DR.)
- **Authorized official phone:** (228) 865-4731

## Contact information

- **Practice address:** 9344 THREE RIVERS RD, GULFPORT, MS 39503-4268
- **Practice address phone:** (228) 865-4731
- **Practice address fax:** (228) 863-5616
- **Mailing address:** PO BOX 2156, GULFPORT, MS 39505-2156
- **Mailing address phone:** (228) 865-4731
- **Mailing address fax:** (228) 863-5616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 12692 | MS | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 08/22/2020