Provider Demographics
NPI:1508049743
Name:BRAIN & SPINE SURGERY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:BRAIN & SPINE SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-970-8225
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5884
Mailing Address - Country:US
Mailing Address - Phone:281-970-8225
Mailing Address - Fax:281-970-8959
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:SUITE 255
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:281-970-8225
Practice Address - Fax:281-970-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176069601Medicaid
TX00154ZMedicare PIN