MEDICARE: RICHMOND SPINAL MANAGEMENT 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
2	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1528626553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND SPINAL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 540774
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0774
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	2404 OAKRIDGE AVE
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-5760
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Authorized Official
Title or Position	:	CEO
Name	:	LOUIS (TREY) C TROSCLAIR III
Credential	:	LSA
Telephone Number	:	214-227-2457

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/30/2022

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