Basic Information
| Provider Information | |||||||||
| NPI: | 1629479019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPINAL NEUROSURGICAL ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 389 | ||||||||
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| City: | COFFEYVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673370389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202521639 | ||||||||
| FaxNumber: | 6202521541 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 S WHEELING AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741045656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187487854 | ||||||||
| FaxNumber: | 9182933116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2014 | ||||||||
| LastUpdateDate: | 09/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | HSU | ||||||||
| AuthorizedOfficialFirstName: | GERY | ||||||||
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| AuthorizedOfficialTitleorPosition: | NEUROLOGICAL SURGON | ||||||||
| AuthorizedOfficialTelephone: | 6202521638 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 30306 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.