| Northern Neurosurgery And Spine Plc | |
|
350 23rd Ave E Ste 102 West Fargo ND 58078-7401 | |
| (701) 356-7444 | |
| (855) 453-4956 |
| Full Name | Northern Neurosurgery And Spine Plc |
|---|---|
| Speciality | Clinic/Center |
| Location | 350 23rd Ave E Ste 102, West Fargo, North Dakota |
| Authorized Official Name and Position | Steven Jared Broadway (OWNER) |
| Authorized Official Contact | 7013567444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Neurosurgery And Spine Plc 350 23rd Ave E Ste 102 West Fargo ND 58078-7401 Ph: (701) 356-7444 | Northern Neurosurgery And Spine Plc 350 23rd Ave E Ste 102 West Fargo ND 58078-7401 Ph: (701) 356-7444 |
| NPI Number | 1386281475 |
|---|---|
| Provider Enumeration Date | 12/08/2019 |
| Last Update Date | 01/11/2024 |
| Medicare PECOS PAC ID | 4082040076 |
|---|---|
| Medicare Enrollment ID | O20200211002329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386281475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Steven Jared Broadway |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1457551228 PECOS PAC ID: 7810166923 Enrollment ID: I20200106001544 |
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