Provider Demographics
NPI:1073828869
Name:NORTHSIDE SPINE CENTER LLC
Entity Type:Organization
Organization Name:NORTHSIDE SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-774-7291
Mailing Address - Street 1:PO BOX 2041
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-2041
Mailing Address - Country:US
Mailing Address - Phone:713-774-7291
Mailing Address - Fax:713-774-5478
Practice Address - Street 1:2807 LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-3405
Practice Address - Country:US
Practice Address - Phone:713-774-7291
Practice Address - Fax:713-774-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital