Revival Spine Surgery LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

REVIVAL SPINE SURGERY LLC

Practice address

621 S New Ballas Rd Ste 589a
Saint Louis, MO 63141

Phone

(314) 690-8383

NPI assigned

Mar 8, 2018

Organization subpart

No

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

Authorized official

Name

Lukasz Curylo, MDNPI 1366481764

Title

MD/President

Phone

(314) 690-8383

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lukasz J Curylo, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Saint Louis, MO
  • NPI 1366481764
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530403200000",
    "number": "1972005676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 589A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 589A",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-690-8383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1920 Sturfield Ct",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631311625",
            "country_code": "US",
            "telephone_number": "314-435-5868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVAL SPINE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-07-01",
        "status": "A",
        "authorized_official_last_name": "CURYLO",
        "authorized_official_first_name": "LUKASZ",
        "authorized_official_title_or_position": "MD/PRESIDENT",
        "authorized_official_telephone_number": "314-690-8383",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Orthopaedic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.