MEDICARE: SPINAL ASSOCIATES OF TEXAS LLC

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	363AS0400X	Surgical Physician Assistant	SA00100	TX

General Provider Information

NPI Number	:	1164855094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL ASSOCIATES OF TEXAS LLC

Provider Business Mailing Address
First Line	:	3740 GREENBRIAR ST UNIT 540774
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 GREENBRIAR ST UNIT 540774
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0869
Country	:	US
Telephone Number	:	281-463-6309
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TREY TROSCLAIR
Credential	:
Telephone Number	:	281-463-6309

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/19/2014

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