Organization
PREMIER SPINE GROUP, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD A FAIRCHILD MD (PRESIDENT)
(715) 544-1774
Entity
Organization
Contact information
Practice address
200 DIVISION ST STE J, STEVENS POINT, WI 54481-1843
(715) 544-1774
(715) 544-1772
Mailing address
520 VINCENT ST, STEVENS POINT, WI 54481-1848
(715) 544-1774
(715) 544-1772
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208600000X
Surgery Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
08/20/2024
Last updated
09/01/2024
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