Provider Demographics
NPI:1770670390
Name:TEXAS BRAIN AND SPINE INSTITUTE PA
Entity Type:Organization
Organization Name:TEXAS BRAIN AND SPINE INSTITUTE PA
Other - Org Name:BRAIN & SPINE CENTER OF TEXAS, LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STACHNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-943-9779
Mailing Address - Street 1:3060 COMMUNICATIONS PARKWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-943-9779
Mailing Address - Fax:972-943-9776
Practice Address - Street 1:3060 COMMUNICATION PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-943-9779
Practice Address - Fax:972-943-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK16343174400000X
207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X233Medicare PIN
TX0A3184Medicare PIN