Provider Demographics
NPI:1013198167
Name:KINGWOOD SPINE CENTER INC.
Entity Type:Organization
Organization Name:KINGWOOD SPINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAQIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-840-0401
Mailing Address - Street 1:33300 EGYPT LN STE C800
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2871
Mailing Address - Country:US
Mailing Address - Phone:713-840-0401
Mailing Address - Fax:832-553-3211
Practice Address - Street 1:350 KINGWOOD MEDICAL DR STE 130
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6406
Practice Address - Country:US
Practice Address - Phone:713-840-0401
Practice Address - Fax:832-553-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty