Provider Demographics
NPI:1407889264
Name:ORTHOPAEDIC & SPINE INSTITUTE LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPINE INSTITUTE LLC
Other - Org Name:SPINE & ORTHOPAEDIC INSTITUTE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-487-7463
Mailing Address - Street 1:PO BOX 848827
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8827
Mailing Address - Country:US
Mailing Address - Phone:210-487-7463
Mailing Address - Fax:210-487-7468
Practice Address - Street 1:21 SPURS LANE
Practice Address - Street 2:SUITE 245
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-487-7463
Practice Address - Fax:210-487-7468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629948207Q00000X
TXK3566207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH80904Medicare UPIN
TX00X165Medicare PIN