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General NPI Number Information
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NPI Number | 1982927265
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS SPINE GROUP PC
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 7097 N EXPY 77 STE 5
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City | OLMITO
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State | TX
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Zip | 78575-9807
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Country | US
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Telephone | 956-518-7305
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Fax | 956-518-7307
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Provider Business Mailing Address
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Address Line | 7097 N EXPY 77 STE 5
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City | OLMITO
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State | TX
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Zip | 78575-9807
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Country | US
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Telephone | 956-518-7305
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Fax | 956-518-7307
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Authorized Official
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Title or Position | OWNER
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Name | MARK W BAILEY
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Credential | FNP, DC
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Telephone | 956-244-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6041
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 776890
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License Number State | TX
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