Provider Demographics
NPI:1366614653
Name:MV SPINE AND JOINT, P.A.
Entity type:Organization
Organization Name:MV SPINE AND JOINT, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-337-6688
Mailing Address - Street 1:711 MIDWAY CRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4335
Mailing Address - Country:US
Mailing Address - Phone:501-337-6688
Mailing Address - Fax:
Practice Address - Street 1:703 US HIGHWAY 90 E
Practice Address - Street 2:SUITE 107
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-5246
Practice Address - Country:US
Practice Address - Phone:830-931-2211
Practice Address - Fax:830-538-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1507251T00000X
TX12929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154829718Medicaid
ARU76643Medicare UPIN
AR154829718Medicaid