1669713137 NPI number — TEXAS PAIN AND SPINE PHYSICIANS

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 1669713137 NPI number — TEXAS PAIN AND SPINE PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS PAIN AND SPINE PHYSICIANS
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:
1669713137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2674
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78630-2674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-388-1190
Provider Business Mailing Address Fax Number:
512-388-1174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7215 WYOMING SPGS
Provider Second Line Business Practice Location Address:
STE 300A
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-388-1190
Provider Business Practice Location Address Fax Number:
512-388-1174
Provider Enumeration Date:
03/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-388-1190

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  P4191 , 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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