Provider Demographics
NPI:1285065920
Name:INTERVENTIONAL SPINE OF TEXAS, PLLC
Entity type:Organization
Organization Name:INTERVENTIONAL SPINE OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-843-7444
Mailing Address - Street 1:6225 FM 2920 RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3474
Mailing Address - Country:US
Mailing Address - Phone:832-843-7444
Mailing Address - Fax:832-592-9254
Practice Address - Street 1:6225 FM 2920 RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3474
Practice Address - Country:US
Practice Address - Phone:832-843-7444
Practice Address - Fax:832-592-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3819174400000X
TXP2477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty