Organization
NEUROSPINAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKI JORDAN (BILLING MANAGER)
(314) 432-2580
Entity
Organization
Contact information
Practice address
226 S WOODS MILL RD, SUITE 54 W, CHESTERFIELD, MO 63017-3662
(314) 388-6513
(314) 878-0847
Mailing address
PO BOX 4520, CAROL STREAM, IL 60197-4520
(314) 432-2580
(314) 991-8960
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R4651
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014163
MEDICARE PTAN
MO
01
—
DB5175
RR MEDICARE GROUP#
MO
Enumeration date
06/11/2006
Last updated
10/05/2016
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