1285065920 NPI number — INTERVENTIONAL SPINE OF TEXAS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285065920 NPI number — INTERVENTIONAL SPINE OF TEXAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL SPINE OF TEXAS, PLLC
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:
1285065920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6225 FM 2920 RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77379-3474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-843-7444
Provider Business Mailing Address Fax Number:
832-592-9254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6225 FM 2920 RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-3474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-843-7444
Provider Business Practice Location Address Fax Number:
832-592-9254
Provider Enumeration Date:
12/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-843-7444

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  P2477 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: N3819 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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