1396074563 NPI number — INNOVATIVE SPINAL SOLUTIONS, PLLC

Table of content: MRS. ERIN KRISTINE CHURCH LICSW (NPI 1083226112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396074563 NPI number — INNOVATIVE SPINAL SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE SPINAL SOLUTIONS, 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:
1396074563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MONET BEND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77382-2050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18929 HIGHWAY 59 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-4270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-446-4053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEAHY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-351-7261

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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