Provider Demographics
NPI:1528463718
Name:BACKBONE SURGICAL SUPPORT, LLC
Entity type:Organization
Organization Name:BACKBONE SURGICAL SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VADHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-231-7720
Mailing Address - Street 1:4582 KINGWOOD DRIVE
Mailing Address - Street 2:STE 187
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345
Mailing Address - Country:US
Mailing Address - Phone:713-269-4564
Mailing Address - Fax:888-426-6435
Practice Address - Street 1:4582 KINGWOOD DR
Practice Address - Street 2:STE 187
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2639
Practice Address - Country:US
Practice Address - Phone:713-269-4564
Practice Address - Fax:888-426-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty