Basic Information
| Provider Information | |||||||||
| NPI: | 1588140263 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL NEUROSURGERY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 875 OAK ST SE STE 5060 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035617246 | ||||||||
| FaxNumber: | 5035617245 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 OAK ST SE STE 5060 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033991386 | ||||||||
| FaxNumber: | 5033991182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2018 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | BORN | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5033991386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CMPE | ||||||||
| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.