MEDICARE: SPINE WORKS MANAGEMENT, 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1821407685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE WORKS MANAGEMENT, PLLC

Provider Business Mailing Address
First Line	:	5566 W MAIN ST STE 210
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-3673
Country	:	US
Telephone Number	:	214-618-5600
Fax Number	:	214-618-7733

Provider Business Practice Location Address
First Line	:	8801 N TARRANT PKWY
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-8461
Country	:	US
Telephone Number	:	817-616-0700
Fax Number	:	817-616-0708

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KIM SIVARAMAN
Credential	:
Telephone Number	:	214-618-5600

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	08/06/2014

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