Spine Team Texas, PA
Organization Active NPI Specialist · Rockwall, TX
NPI 1609009505 · NPPES record last updated Jun 25, 2014
Key facts
- NPI
- 1609009505
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- SPINE TEAM TEXAS, PA
- Practice address
- 3142 Horizon Rd
Suite 100
Rockwall, TX 75032-7809 - Phone
- (817) 442-9300
- Fax
- (817) 796-0763
- NPI assigned
- Aug 26, 2009
- Organization subpart
- No
Authorized official
- Name
- Mark Hood
- Title
- Ceo
- Phone
- (817) 442-9300
Other NPIs on the same Medicare enrollment 3
Practitioners 44
-
Rebecca Maiden Allen, CRNA
-
Laura Denny Bates, CRNA
-
Sharon Beaver, CRNA
-
Cathy Hang Bedolla, CRNA
-
Mary Charlene Berg, CRNA
-
Brandon Raymond Brock, CRNA
-
Kenton Wayne Dubose, CRNA, DNP
-
Asfaw Berhanu Getaw, ARPN-CRNA
-
Samantha Lee Graling, CRNA
-
Brooks Ross Greger II, CRNA
-
Deborah R. Grieder, CRNA
-
Catherine Hack, CRNA
-
Bradley C. Harville, CRNA
-
Jerral G Hopper, RN,CRNA
-
Jean Marie Hunt, CRNA
-
Gayle Marie Jasinski, PA-C
-
Paul I Maduka, CRNA
-
Deaann L Martin, CRNA
-
Pamela A. Matlock, CRNA
-
Mauro Alberto Molina, CRNA
-
Kathleen M. Mulvey, CRNA
-
Andrea L Nemit, CRNA
-
Kelly Amanda Merritt Nichols, CRNA, DNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051230000616 | TX | Part B Supplier - Clinic/Group Practice | 6507888757 |
Receives reassigned benefits from 132 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fort Worth, TX; Rockwall, TX; Southlake, TX |
National Provider Directory
Locations
10900 Founders Way
Ste 100
Fort Worth, TX 76244
Phone (682) 651-1908
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
3142 Horizon Rd
Suite 100
Rockwall, TX 75032-7809
Mailing address
1545 E Southlake Blvd
Suite 100
Southlake, TX 76092-6422
Phone (817) 442-9300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00957Z | Other | TX | MEDICARE PTAN |
Other providers in Rockwall, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.