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General NPI Number Information
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NPI Number | 1265969562
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Entity Type | Organization
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Legal Business Name | LONE STAR SPINE INSTITUTE, PA
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3600 W 7TH ST STE A
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City | FORT WORTH
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State | TX
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Zip | 76107-2534
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Country | US
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Telephone | 817-429-4545
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Fax | 817-429-4547
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Provider Business Mailing Address
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Address Line | 729 W BEDFORD-EULESS RD STE 206
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City | HURST
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State | TX
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Zip | 76053
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Country | US
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Telephone | 817-288-0084
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Fax | 817-445-1039
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SHAWN HENRY
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Credential | DO
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Telephone | 817-429-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | L2316
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License Number State | TX
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