Provider Demographics
NPI:1497088207
Name:NINH NEUROSPINE INSTITUTE PA
Entity Type:Organization
Organization Name:NINH NEUROSPINE INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:V
Authorized Official - Last Name:NINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-412-5544
Mailing Address - Street 1:11711 SHADOW CREEK PKWY
Mailing Address - Street 2:STE 147
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7232
Mailing Address - Country:US
Mailing Address - Phone:832-243-4969
Mailing Address - Fax:832-598-2478
Practice Address - Street 1:11711 SHADOW CREEK PKWY
Practice Address - Street 2:STE 147
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7232
Practice Address - Country:US
Practice Address - Phone:832-243-4969
Practice Address - Fax:832-598-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9284111N00000X, 111NR0400X
TXN2690208100000X, 332B00000X
TXTX26902081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5189Medicare PIN
TX6383400001Medicare NSC