Provider Demographics
NPI:1033656574
Name:TEXAS SPINE AND JOINT HOSPITAL, LLC
Entity Type:Organization
Organization Name:TEXAS SPINE AND JOINT HOSPITAL, LLC
Other - Org Name:BAYLOR SCOTT & WHITE TEXAS SPINE & JOINT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:1814 ROSELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4234
Mailing Address - Country:US
Mailing Address - Phone:903-525-3330
Mailing Address - Fax:
Practice Address - Street 1:2211 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4701
Practice Address - Country:US
Practice Address - Phone:903-729-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162459501Medicaid
TXTXB138589Medicare PIN