Provider Demographics
NPI:1093874570
Name:JAMES V STONECIPHER MD PA
Entity Type:Organization
Organization Name:JAMES V STONECIPHER MD PA
Other - Org Name:TEXAS PAIN & SPINE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:STONECIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-774-1377
Mailing Address - Street 1:PO BOX 10797
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0797
Mailing Address - Country:US
Mailing Address - Phone:979-774-1377
Mailing Address - Fax:979-774-6147
Practice Address - Street 1:3841 SAGEBRIAR DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-6107
Practice Address - Country:US
Practice Address - Phone:979-774-1377
Practice Address - Fax:979-774-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154804201Medicaid
TX154804201Medicaid
TX00822TMedicare ID - Type UnspecifiedGROUP NUMBER