Organization Active NPI

Texas Health Spine Surgery Center Allen, LLC

  • Ambulatory Surgical Clinic/Center
  • Allen, TX
National Provider Identifier
1881124550
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
TEXAS HEALTH SPINE SURGERY CENTER ALLEN, LLC
Practice address
1120 Raintree Circle
Suite 100
Allen, TX 75013
Phone
(817) 442-9300
Fax
(682) 651-1925
NPI assigned
Jun 15, 2017
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Gatley Hebard
Title
Ceo
Phone
(817) 442-9300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X TX Primary

Addresses

Primary practice location

1120 Raintree Circle
Suite 100
Allen, TX 75013

Mailing address

1340 S Main St Ste 100
Grapevine, TX 76051-5547
Phone (682) 651-1908

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180321000091 TX Part B Supplier - Ambulatory Surgical Center 6305108861 Practice locations: Allen, TX

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Texas Health Spine Surgery Center Allen LLCCCN 45C0001650
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2142702Texas Health Spine Surgery Center Allen, LLC1120 Raintree Circle Suite 100, Allen, TX 75013Certificate of waiverJan 17, 2028

National Provider Directory

National Provider Directory

Locations

1120 Raintree Cir
Ste 100
Allen, TX 75013
Phone (469) 675-1876

1340 S Main St
Ste 100
Grapevine, TX 76051
Phone (682) 651-1908

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1881124550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 S MAIN ST STE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760515547",
            "telephone_number": "682-651-1908",
            "fax_number": "682-651-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 RAINTREE CIRCLE",
            "address_2": "SUITE 100",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "75013",
            "telephone_number": "817-442-9300",
            "fax_number": "682-651-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS HEALTH SPINE SURGERY CENTER ALLEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-15",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "HEBARD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "GATLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-442-9300"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.