MEDICARE: SPINALWORKS MEDICAL GROUP, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1750877767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINALWORKS MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	2821 ROUTH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1414
Country	:	US
Telephone Number	:	214-296-0269
Fax Number	:	469-212-1188

Provider Business Practice Location Address
First Line	:	2821 ROUTH ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1414
Country	:	US
Telephone Number	:	214-296-0269
Fax Number	:	469-212-1188

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. MATTHEW CARTER
Credential	:
Telephone Number	:	214-296-0269

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	07/03/2018

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