Provider Demographics
NPI:1609834761
Name:TEXAS BRAIN AND SPINE CENTER, P.A
Entity Type:Organization
Organization Name:TEXAS BRAIN AND SPINE CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-922-5099
Mailing Address - Street 1:333 N TEXAS AVE
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4966
Mailing Address - Country:US
Mailing Address - Phone:281-922-5099
Mailing Address - Fax:281-922-5490
Practice Address - Street 1:333 N TEXAS AVE
Practice Address - Street 2:SUITE 3200
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4966
Practice Address - Country:US
Practice Address - Phone:281-922-5099
Practice Address - Fax:281-922-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3995174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143436702Medicaid
TX143436701Medicaid
TX143436701Medicaid
TX143436702Medicaid