Provider Demographics
NPI:1689967424
Name:SPINE PHYSICIANS INSTITUTE PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:SPINE PHYSICIANS INSTITUTE PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-741-7189
Mailing Address - Street 1:3450 FOREST LN STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7714
Mailing Address - Country:US
Mailing Address - Phone:972-741-7189
Mailing Address - Fax:214-614-1448
Practice Address - Street 1:3450 FOREST LN STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7714
Practice Address - Country:US
Practice Address - Phone:972-741-7189
Practice Address - Fax:214-614-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6010207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB144935Medicare PIN