MEDICARE: INSTITUTE OF SPINE AND PAIN 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1811432552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF SPINE AND PAIN SOLUTIONS PLLC

Provider Business Mailing Address
First Line	:	5701 BRYANT IRVIN RD STE 304
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4027
Country	:	US
Telephone Number	:	682-478-8123
Fax Number	:	888-851-5356

Provider Business Practice Location Address
First Line	:	5701 BRYANT IRVIN RD STE 304
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4027
Country	:	US
Telephone Number	:	682-478-8123
Fax Number	:	888-851-5356

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. BRYAN SKULPOONKITTI
Credential	:	DO
Telephone Number	:	682-478-8123

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	08/12/2025

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