Basic Information
Provider Information | |||||||||
NPI: | 1477853752 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CENTER FOR NEUROSCIENCES ORTHOPEDICS & SPINE PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1430 | ||||||||
Address2: |   | ||||||||
City: | DAKOTA DUNES | ||||||||
State: | SD | ||||||||
PostalCode: | 570491430 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6052172667 | ||||||||
FaxNumber: | 6052172900 | ||||||||
Practice Location | |||||||||
Address1: | 701 E 2ND ST | ||||||||
Address2: |   | ||||||||
City: | IDA GROVE | ||||||||
State: | IA | ||||||||
PostalCode: | 514451666 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6052172667 | ||||||||
FaxNumber: | 6052172900 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2010 | ||||||||
LastUpdateDate: | 06/18/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DURWARD | ||||||||
AuthorizedOfficialFirstName: | QUENTIN | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/BOARD OF DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 6052172667 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.