Provider Demographics
NPI:1972799435
Name:NORTH CENTRAL TEXAS SPINE INSTITUTE
Entity type:Organization
Organization Name:NORTH CENTRAL TEXAS SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-288-0084
Mailing Address - Street 1:729 W BEDFORD EULESS RD STE 206
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3941
Mailing Address - Country:US
Mailing Address - Phone:817-288-0084
Mailing Address - Fax:817-445-1039
Practice Address - Street 1:729 W BEDFORD EULESS RD STE 206
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3941
Practice Address - Country:US
Practice Address - Phone:817-288-0084
Practice Address - Fax:817-445-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1579207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y155Medicare PIN