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General NPI Number Information
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NPI Number | 1285065920
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL SPINE OF TEXAS, PLLC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 6225 FM 2920 RD SUITE 203
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City | SPRING
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State | TX
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Zip | 77379-3474
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Country | US
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Telephone | 832-843-7444
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Fax | 832-592-9254
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Provider Business Mailing Address
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Address Line | 6225 FM 2920 RD SUITE 203
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City | SPRING
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State | TX
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Zip | 77379-3474
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Country | US
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Telephone | 832-843-7444
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Fax | 832-592-9254
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH L LE
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Credential | M.D.
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Telephone | 832-843-7444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | P2477
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | N3819
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License Number State | TX
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