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General NPI Number Information
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NPI Number | 1497283048
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Entity Type | Organization
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Legal Business Name | SPINETECH SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 950 N 11TH ST
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City | BEAUMONT
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State | TX
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Zip | 77702-1203
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Country | US
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Telephone | 409-833-0193
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Fax | 844-873-4788
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Provider Business Mailing Address
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Address Line | 755 S 11TH ST STE 102
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City | BEAUMONT
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State | TX
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Zip | 77701-3723
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Country | US
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Telephone | 409-892-8237
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Fax | 409-898-0177
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHUN BRACE
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Credential |
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Telephone | 409-234-7088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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