Organization
SPINE SURGERY, PSC
Active
Parent organization
SPINE SURGERY, PSC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPINE SURGERY, PSC
Authorized official
MRS. LINETTE M GADWAH (CREDENTIALING COORDINATOR)
(502) 585-2300
Entity
Organization
Contact information
Practice address
210 E GRAY ST, SUITE 601, LOUISVILLE, KY 40202-3902
(502) 585-2300
(502) 584-2726
Mailing address
210 E GRAY ST, SUITE 601, LOUISVILLE, KY 40202-3902
(502) 585-2300
(502) 584-2726
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65918583
—
KY
Enumeration date
12/22/2005
Last updated
04/07/2008
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