Organization
SPA CARE OF PENN II, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD LELAND HUTTON EADIE (DIRECTOR)
(615) 733-2064
Entity
Organization
Contact information
Practice address
1700 MARKET ST STE 1005B216, PHILADELPHIA, PA 19103-3913
(615) 386-0064
Mailing address
102 WOODMONT BLVD STE 350, NASHVILLE, TN 37205-2216
(615) 733-2064
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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