1700014826 NPI number — FRISCO SPINE, PA

Table of content: (NPI 1700014826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700014826 NPI number — FRISCO SPINE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRISCO SPINE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700014826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-0225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-506-2610
Provider Business Mailing Address Fax Number:
972-681-8727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8350 DALLAS PKWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-377-9200
Provider Business Practice Location Address Fax Number:
972-377-9300
Provider Enumeration Date:
06/26/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PALACIOS
Authorized Official First Name:
BRISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
469-294-8926

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)