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General NPI Number Information
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NPI Number | 1235308578
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Entity Type | Organization
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Legal Business Name | ADVANCED SPINE SOLUTIONS PA
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 261 W SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7046
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Country | US
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Telephone | 817-310-8783
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Fax | 855-640-3872
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Provider Business Mailing Address
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Address Line | 2813 W SOUTHLAKE BLVD SUITE #100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6829
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Country | US
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Telephone | 817-310-8783
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Fax | 817-431-0735
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. KEVIN B JAMES
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Credential | MD
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Telephone | 817-310-8783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | M4201
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License Number State | TX
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