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General NPI Number Information
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NPI Number | 1730696956
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Entity Type | Organization
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Legal Business Name | 365 SPINE CARE OF NORTH TEXAS, PLLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 8080 INDEPENDENCE PKWY STE 230
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City | PLANO
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State | TX
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Zip | 75025-4013
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Country | US
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Telephone | 469-693-0165
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Fax |
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Provider Business Mailing Address
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Address Line | 8080 INDEPENDENCE PKWY STE 230
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City | PLANO
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State | TX
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Zip | 75025-4013
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Country | US
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Telephone | 469-693-0165
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KENDALL EDWARD CARLL II
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Credential | MD
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Telephone | 469-693-0165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | TRN6843
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License Number State | FL
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Taxonomy #2
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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 | M8573
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License Number State | TX
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