MEDICARE: SPINE DISORDERS OF TEXAS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1053185603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE DISORDERS OF TEXAS PLLC

Provider Business Mailing Address
First Line	:	1029 LONG PRAIRIE RD STE D
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4344
Country	:	US
Telephone Number	:	602-218-6556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 LONG PRAIRIE RD STE D
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4344
Country	:	US
Telephone Number	:	602-218-6556
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUANE PITT
Credential	:	MD
Telephone Number	:	602-218-6556

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/16/2023

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