Provider Demographics
NPI:1073920732
Name:MINIMAL ACCESS SPINE TECHNOLOGY
Entity Type:Organization
Organization Name:MINIMAL ACCESS SPINE TECHNOLOGY
Other - Org Name:EBOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VADHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-231-7720
Mailing Address - Street 1:PO BOX 1651
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1651
Mailing Address - Country:US
Mailing Address - Phone:281-462-7684
Mailing Address - Fax:888-832-5078
Practice Address - Street 1:4582 KINGWOOD DR
Practice Address - Street 2:SUITE 187
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-2639
Practice Address - Country:US
Practice Address - Phone:281-462-7684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty