Provider Demographics
NPI:1790109734
Name:SPINE VUE, PLLC
Entity Type:Organization
Organization Name:SPINE VUE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MAWUSI
Authorized Official - Last Name:JONES-QUAIDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-452-7705
Mailing Address - Street 1:8440 WALNUT HILL LN STE 230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3816
Mailing Address - Country:US
Mailing Address - Phone:214-452-7705
Mailing Address - Fax:214-377-8831
Practice Address - Street 1:8440 WALNUT HILL LN STE 230
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3816
Practice Address - Country:US
Practice Address - Phone:214-452-7705
Practice Address - Fax:214-377-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3361207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349891Medicare PIN
TX7115360001Medicare NSC