Provider Demographics
NPI:1720434731
Name:NEW BRAUNFELS SPINE & PAIN SURGERY
Entity type:Organization
Organization Name:NEW BRAUNFELS SPINE & PAIN SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-387-2343
Mailing Address - Street 1:717 GENERATIONS
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0005
Mailing Address - Country:US
Mailing Address - Phone:830-387-2343
Mailing Address - Fax:830-627-9144
Practice Address - Street 1:717 GENERATIONS
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0005
Practice Address - Country:US
Practice Address - Phone:830-387-2343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3877854Medicaid