NPIMap

Organization Active NPI

Iconiq Spine & Orthopaedic Center PLLC

Doing business as Holistiq Spine & Orthopaedic Clinic

  • Durable Medical Equipment & Medical Supplies
  • Fort Worth, TX
National Provider Identifier
1982440426
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
ICONIQ SPINE & ORTHOPAEDIC CENTER PLLC
Doing business as
Holistiq Spine & Orthopaedic Clinic
Practice address
817 W Tucker St
Fort Worth, TX 76104-2236
Phone
(469) 444-7246
NPI assigned
Jul 3, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Authorized official

Name
Trung Van HaNPI 1780936971
Title
Authorized Official
Phone
(469) 444-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

817 W Tucker St
Fort Worth, TX 76104-2236

Mailing address

4441 W Airport Fwy Ste 215
Irving, TX 75062-5959

Other names 1

  • HOLISTIQ SPINE & ORTHOPAEDIC CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Holistiq Spine Orthopaedic Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

817 W Tucker St
Fort Worth, TX 76104
Phone (469) 444-7246

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1982440426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4441 W AIRPORT FWY STE 215",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750625959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 W TUCKER ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042236",
            "telephone_number": "469-444-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIQ SPINE & ORTHOPAEDIC CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "HA",
        "authorized_official_first_name": "TRUNG",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "469-444-7246"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HOLISTIQ SPINE & ORTHOPAEDIC CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.