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General NPI Number Information
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NPI Number | 1336562214
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Entity Type | Organization
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Legal Business Name | SPRING SPINE AND WELLNESS, PA
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 19510 KUYKENDAHL RD SUITE A
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City | SPRING
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State | TX
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Zip | 77379
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Country | US
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Telephone | 832-324-5385
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Fax |
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Provider Business Mailing Address
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Address Line | 26400 KUYKENDAHL RD SUITE C-180-240
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City | THE WOODLANDS
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State | TX
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Zip | 77375
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Country | US
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Telephone | 832-324-5385
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. EDWARD ALAN NASH
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Credential | M.D.
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Telephone | 832-324-5385
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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 | M3662
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License Number State | TX
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