MEDICARE: TEXAS REGIONAL SPINE CENTER, PA

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

General Provider Information

NPI Number	:	1518326859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS REGIONAL SPINE CENTER, PA

Provider Business Mailing Address
First Line	:	9400 WESTHEIMER RD STE 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 WESTHEIMER RD STE 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-3468
Country	:	US
Telephone Number	:	214-295-2830
Fax Number	:

Authorized Official
Title or Position	:	HEALTHCARE INFORMATICS
Name	:	KENYA WATTS
Credential	:
Telephone Number	:	214-425-6790

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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