Provider Demographics
NPI:1174166201
Name:NEUROSURGICAL SPINE INSTITUTE LLC
Entity type:Organization
Organization Name:NEUROSURGICAL SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGOROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-483-4000
Mailing Address - Street 1:2484 CARING WAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2484 CARING WAY UNIT C
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5306
Practice Address - Country:US
Practice Address - Phone:941-483-4000
Practice Address - Fax:941-480-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty