Northeast PA Neuro-Spine, P.C.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

NORTHEAST PA NEURO-SPINE, P.C.

Practice address

414 E Drinker St
Dunmore, PA 18512-2469

Phone

(570) 558-3540

Fax

(570) 558-3547

NPI assigned

Jun 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Philip J Hlavac, M.D.

Title

Physician

Phone

(570) 558-3540

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114953429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 W OLIVE ST",
            "address_2": "STE 201",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185082572",
            "telephone_number": "570-969-0663",
            "fax_number": "570-969-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 E DRINKER ST",
            "city": "DUNMORE",
            "state": "PA",
            "postal_code": "185122469",
            "telephone_number": "570-558-3540",
            "fax_number": "570-558-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST PA NEURO-SPINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HLAVAC",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "570-558-3540",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "1832581",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.