Provider Demographics
NPI:1790008548
Name:PREMIER SPINE ASSOCIATES OF NORTH TEXAS
Entity Type:Organization
Organization Name:PREMIER SPINE ASSOCIATES OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBUULE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-497-2126
Mailing Address - Street 1:2904 FRANCISCAN DR
Mailing Address - Street 2:SUITE 1628
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2574
Mailing Address - Country:US
Mailing Address - Phone:214-497-2126
Mailing Address - Fax:214-295-9795
Practice Address - Street 1:7989 W VIRGINIA DR
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3837
Practice Address - Country:US
Practice Address - Phone:214-556-3371
Practice Address - Fax:214-295-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0166207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty