Provider Demographics
NPI:1790210417
Name:SPINE ORTHOPAEDIC & PAIN SURGICAL PARTNERS LLC
Entity Type:Organization
Organization Name:SPINE ORTHOPAEDIC & PAIN SURGICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-984-8799
Mailing Address - Street 1:15119 WALLISVILLE RD
Mailing Address - Street 2:#200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4630
Mailing Address - Country:US
Mailing Address - Phone:281-984-8799
Mailing Address - Fax:832-941-5533
Practice Address - Street 1:15119 WALLISVILLE RD
Practice Address - Street 2:#200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4630
Practice Address - Country:US
Practice Address - Phone:281-984-8799
Practice Address - Fax:832-941-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9835207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty