Healthcare Provider Details

I. General information

NPI: 1073963104
Provider Name (Legal Business Name): DISCOUNT SPINE CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 FM 2920 RD STE 100
SPRING TX
77379-2613
US

IV. Provider business mailing address

6535 FM 2920 RD STE 100
SPRING TX
77379-2613
US

V. Phone/Fax

Practice location:
  • Phone: 214-425-6790
  • Fax: 972-519-0568
Mailing address:
  • Phone: 214-425-6790
  • Fax: 972-519-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENYA DELCASTILLO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 214-425-6790