Healthcare Provider Details

I. General information

NPI: 1285827980
Provider Name (Legal Business Name): WOODLANDS SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33300 EGYPT LN STE F200
MAGNOLIA TX
77354-2741
US

IV. Provider business mailing address

33300 EGYPT LN STE F200
MAGNOLIA TX
77354-2741
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-1121
  • Fax: 832-553-3211
Mailing address:
  • Phone: 281-702-0173
  • Fax: 832-553-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM0921
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberM0921
License Number StateTX

VIII. Authorized Official

Name: DR. SAQIB A SIDDIQUI
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 281-841-8696