Provider Demographics
NPI:1265865158
Name:BRAIN AND SPINE CENTER OF SOUTHEAST TEXAS, PLLC
Entity Type:Organization
Organization Name:BRAIN AND SPINE CENTER OF SOUTHEAST TEXAS, PLLC
Other - Org Name:SPINETECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-234-7088
Mailing Address - Street 1:6025 METROPOLITAN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2407
Mailing Address - Country:US
Mailing Address - Phone:409-234-7088
Mailing Address - Fax:409-892-8237
Practice Address - Street 1:6025 METROPOLITAN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2407
Practice Address - Country:US
Practice Address - Phone:409-234-7088
Practice Address - Fax:409-892-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty