Provider Demographics
NPI:1548570708
Name:COMPREHENSIVE SPINE CENTER OF DALLAS
Entity Type:Organization
Organization Name:COMPREHENSIVE SPINE CENTER OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-782-9222
Mailing Address - Street 1:18601 LBJ FWY STE 618
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5615
Mailing Address - Country:US
Mailing Address - Phone:214-782-9222
Mailing Address - Fax:214-782-9333
Practice Address - Street 1:18601 LBJ FWY STE 618
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5615
Practice Address - Country:US
Practice Address - Phone:214-782-9222
Practice Address - Fax:214-782-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5154207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB119539Medicare PIN