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Organization

SPINECARE MEDICAL GROUP INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES B REYNOLDS MD (MEDICAL DOCTOR)
(650) 985-7500
Entity
Organization

Contact information

Practice address
455 HICKEY BLVD, SUITE 310, DALY CITY, CA 94015
(650) 985-7500
(650) 731-4434
Mailing address
455 HICKEY BLVD, SUITE 310, DALY CITY, CA 94015
(650) 985-7500
(650) 731-4434

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
207LP2900X
Pain Medicine (Anesthesiology) Physician
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
208VP0000X
Pain Medicine Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CD7208
MEDICARE RAILROAD GRP#
CA
05
GR0041210
CA
01
ZZZ19182Z
BLUE SHIELD GRP#
CA
Enumeration date
02/02/2006
Last updated
02/14/2018
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