Provider Demographics
NPI:1538717483
Name:SPINE HYDER PC
Entity type:Organization
Organization Name:SPINE HYDER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ZESHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-797-7463
Mailing Address - Street 1:11055 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7300
Mailing Address - Country:US
Mailing Address - Phone:219-797-7463
Mailing Address - Fax:219-310-8951
Practice Address - Street 1:11055 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7300
Practice Address - Country:US
Practice Address - Phone:219-797-7463
Practice Address - Fax:219-310-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies