Provider Demographics
NPI:1205415494
Name:UNIVERSITY SPINE AND NEUROSURGERY LLC
Entity Type:Organization
Organization Name:UNIVERSITY SPINE AND NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:800-713-8519
Mailing Address - Street 1:7601 W SAM HOUSTON PKWY S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:77072
Mailing Address - Country:US
Mailing Address - Phone:800-713-8519
Mailing Address - Fax:888-565-2928
Practice Address - Street 1:7601 W SAM HOUSTON PKWY S STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5239
Practice Address - Country:US
Practice Address - Phone:800-713-8519
Practice Address - Fax:888-565-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty