Provider Demographics
NPI:1578610564
Name:HOLDINGS OF SPINECARE, LLC
Entity Type:Organization
Organization Name:HOLDINGS OF SPINECARE, LLC
Other - Org Name:SPINECARE LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-6285
Mailing Address - Street 1:5734 SPOHN DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4116
Mailing Address - Country:US
Mailing Address - Phone:361-724-3292
Mailing Address - Fax:361-371-7268
Practice Address - Street 1:5734 SPOHN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4116
Practice Address - Country:US
Practice Address - Phone:361-724-3292
Practice Address - Fax:361-371-7268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLDINGS OF SPINECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-04
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008169261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45C0001429Medicare ID - Type UnspecifiedMC ID FOR ASC