Provider Demographics
NPI:1275922668
Name:GULF COAST SPINE SPECIALTIES
Entity Type:Organization
Organization Name:GULF COAST SPINE SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-796-3209
Mailing Address - Street 1:4120 SOUTHWEST FWY
Mailing Address - Street 2:200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7339
Mailing Address - Country:US
Mailing Address - Phone:713-796-3209
Mailing Address - Fax:713-583-1841
Practice Address - Street 1:4120 SOUTHWEST FWY
Practice Address - Street 2:200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7339
Practice Address - Country:US
Practice Address - Phone:713-796-3209
Practice Address - Fax:713-583-1841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON TEXAS PAIN MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty