Provider Demographics
NPI:1871986760
Name:GROSSE POINTE SPINE DME
Entity type:Organization
Organization Name:GROSSE POINTE SPINE DME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TECHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-259-8254
Mailing Address - Street 1:7207 STREAMSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7207 STREAMSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8816
Practice Address - Country:US
Practice Address - Phone:970-222-9745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROSSE POINTE SPINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies