MEDICARE: TEXAS BRAIN AND SPINE INSTITUTE, 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	2084N0400X	Neurology Physician
2	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1518676006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS BRAIN AND SPINE INSTITUTE, PLLC

Provider Business Mailing Address
First Line	:	2705 W ARKANSAS LN
Second Line	:
City	:	DALWORTHINGTON GARDENS
State	:	TX
Zip	:	76016-5818
Country	:	US
Telephone Number	:	817-701-4253
Fax Number	:	817-701-4258

Provider Business Practice Location Address
First Line	:	2705 W ARKANSAS LN
Second Line	:
City	:	DALWORTHINGTON GARDENS
State	:	TX
Zip	:	76016-5818
Country	:	US
Telephone Number	:	817-701-4253
Fax Number	:	817-701-4258

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SABATINO BIANCO
Credential	:	MD
Telephone Number	:	817-701-4253

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	11/23/2022

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