Provider Demographics
NPI:1376835736
Name:SOUTH TEXAS BACK CLINIC INC
Entity Type:Organization
Organization Name:SOUTH TEXAS BACK CLINIC INC
Other - Org Name:SOUTH TEXAS SPINE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:F
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-513-1703
Mailing Address - Street 1:9114 MCPHERSON ROAD
Mailing Address - Street 2:SUITE 2505
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6511
Mailing Address - Country:US
Mailing Address - Phone:956-726-9886
Mailing Address - Fax:956-722-1590
Practice Address - Street 1:9114 MCPHERSON ROAD
Practice Address - Street 2:SUITE 2505
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6511
Practice Address - Country:US
Practice Address - Phone:956-726-9886
Practice Address - Fax:956-722-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11212111N00000X
TX5449111N00000X
TXF0914439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty