Provider Demographics
NPI:1669805677
Name:SPINE AND BRAIN NEUROSURGICAL CARE
Entity type:Organization
Organization Name:SPINE AND BRAIN NEUROSURGICAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-971-0014
Mailing Address - Street 1:3256 LOCH NESS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1239
Mailing Address - Country:US
Mailing Address - Phone:859-971-0014
Mailing Address - Fax:859-971-0074
Practice Address - Street 1:3256 LOCH NESS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1239
Practice Address - Country:US
Practice Address - Phone:859-971-0014
Practice Address - Fax:859-971-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100255040Medicaid
KY7100255040Medicaid