Healthcare Provider Details

I. General information

NPI: 1497088207
Provider Name (Legal Business Name): NINH NEUROSPINE INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 SHADOW CREEK PKWY STE 147
PEARLAND TX
77584-7232
US

IV. Provider business mailing address

11711 SHADOW CREEK PKWY STE 147
PEARLAND TX
77584-7232
US

V. Phone/Fax

Practice location:
  • Phone: 832-243-4969
  • Fax: 832-598-2478
Mailing address:
  • Phone: 832-243-4969
  • Fax: 832-598-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9284
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number9284
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberN2690
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN2690
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberTX2690
License Number StateTX

VIII. Authorized Official

Name: DR. JIMMY V NINH
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 281-412-5544