MEDICARE: INTEGRATED SPINAL SOLUTIONS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1104247634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED SPINAL SOLUTIONS, PLLC

Provider Business Mailing Address
First Line	:	6001 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4103
Country	:	US
Telephone Number	:	817-768-3899
Fax Number	:	817-370-6401

Provider Business Practice Location Address
First Line	:	6001 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4103
Country	:	US
Telephone Number	:	817-768-3899
Fax Number	:	817-370-6401

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LEE BRANDON HARTMAN
Credential	:
Telephone Number	:	817-370-6350

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	06/21/2024

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