MEDICARE: NEW BRAUNFELS SPINE & PAIN SURGERY

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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720434731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BRAUNFELS SPINE & PAIN SURGERY

Provider Business Mailing Address
First Line	:	717 GENERATIONS
Second Line	:	SUITE A
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-0005
Country	:	US
Telephone Number	:	830-387-2343
Fax Number	:	830-627-9144

Provider Business Practice Location Address
First Line	:	717 GENERATIONS
Second Line	:	SUITE A
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-0005
Country	:	US
Telephone Number	:	830-387-2343
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LAURIE BAILEY
Credential	:
Telephone Number	:	830-387-2343

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	08/23/2019

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Directions to “NEW BRAUNFELS SPINE & PAIN SURGERY ” Practice Location

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