1083634299 NPI number — TEXAS SPINE INSTITUTE, LLP

Table of content: (NPI 1083634299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083634299 NPI number — TEXAS SPINE INSTITUTE, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS SPINE INSTITUTE, LLP
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:
TEXAS REHABILITATION SOLUTIONS
Provider Other Organization Name Type Code:
3
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:
1083634299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2028
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:
75034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-727-7246
Provider Business Mailing Address Fax Number:
469-727-7833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 YORK DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-727-7246
Provider Business Practice Location Address Fax Number:
469-727-7833
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAGLE
Authorized Official First Name:
SUNJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATING PARTNER
Authorized Official Telephone Number:
469-727-7246

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com