Provider Demographics
NPI:1073963104
Name:DISCOUNT SPINE CARE PA
Entity Type:Organization
Organization Name:DISCOUNT SPINE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELCASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-425-6790
Mailing Address - Street 1:6535 FM 2920 RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2613
Mailing Address - Country:US
Mailing Address - Phone:214-425-6790
Mailing Address - Fax:972-519-0568
Practice Address - Street 1:6535 FM 2920 RD
Practice Address - Street 2:STE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2613
Practice Address - Country:US
Practice Address - Phone:214-425-6790
Practice Address - Fax:972-519-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty