Provider Demographics
NPI:1316378367
Name:EQUINOX SPINE PA
Entity Type:Organization
Organization Name:EQUINOX SPINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLIE
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-384-1642
Mailing Address - Street 1:7712 SAN JACINTO PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3212
Mailing Address - Country:US
Mailing Address - Phone:972-707-0005
Mailing Address - Fax:888-992-6199
Practice Address - Street 1:7712 SAN JACINTO PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3212
Practice Address - Country:US
Practice Address - Phone:972-707-0005
Practice Address - Fax:888-992-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7365207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty