Provider Demographics
NPI:1962596106
Name:NORTH TEXAS SPINE CARE, INC
Entity type:Organization
Organization Name:NORTH TEXAS SPINE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-583-7574
Mailing Address - Street 1:2110 N CENTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2628
Mailing Address - Country:US
Mailing Address - Phone:903-583-7574
Mailing Address - Fax:
Practice Address - Street 1:2110 N CENTER ST STE A
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2628
Practice Address - Country:US
Practice Address - Phone:903-583-7574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF003686261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068EVOtherBCBS FACILITY NUMBER
TXDR8070OtherMEDICARE RAILROAD CARRIER
TXF003686OtherFACILITY CERTIFICATE
TXF003686OtherFACILITY CERTIFICATE