Provider Demographics
NPI:1386037273
Name:PRISM ORTHOPEDIC
Entity Type:Organization
Organization Name:PRISM ORTHOPEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-378-4661
Mailing Address - Street 1:PO BOX 674074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4074
Mailing Address - Country:US
Mailing Address - Phone:214-396-3936
Mailing Address - Fax:888-624-8659
Practice Address - Street 1:7712 SAN JACINTO PL STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3212
Practice Address - Country:US
Practice Address - Phone:214-378-4661
Practice Address - Fax:888-624-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7365207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherSPINE SURGERY