Provider Demographics
NPI:1053520064
Name:THE SPINE AND JOINT CENTER
Entity type:Organization
Organization Name:THE SPINE AND JOINT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-860-1900
Mailing Address - Street 1:7300 HANOVER DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2013
Mailing Address - Country:US
Mailing Address - Phone:301-860-1900
Mailing Address - Fax:301-860-1909
Practice Address - Street 1:7300 HANOVER DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2013
Practice Address - Country:US
Practice Address - Phone:301-860-1900
Practice Address - Fax:301-860-1909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SPINE AND JOINT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1257111000Medicaid
MD1257111000Medicaid