Provider Demographics
NPI:1699165720
Name:CENTER FOR ENDOSCOPIC SPINE SURGERY, LLC
Entity type:Organization
Organization Name:CENTER FOR ENDOSCOPIC SPINE SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:832-223-9200
Mailing Address - Street 1:7830 W GRAND PKWY S
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7830 W GRAND PKWY S
Practice Address - Street 2:SUITE 150
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5816
Practice Address - Country:US
Practice Address - Phone:832-223-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical