MEDICARE: DISC CLINIC 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	207X00000X	Orthopaedic Surgery Physician
2	207XS0117X	Orthopaedic Surgery of the Spine Physician		TX

General Provider Information

NPI Number	:	1457704835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISC CLINIC PLLC

Provider Business Mailing Address
First Line	:	7712 SAN JACINTO PL STE 200
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3212
Country	:	US
Telephone Number	:	972-707-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 N TARRANT PKWY STE 404
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8614
Country	:	US
Telephone Number	:	972-707-0005
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK VALENTE
Credential	:	D.O.
Telephone Number	:	972-707-0005

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	08/09/2016

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