Provider Demographics
NPI:1881833200
Name:TEXAS PAIN & SPINE INSTITUTE
Entity Type:Organization
Organization Name:TEXAS PAIN & SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRADDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-353-6100
Mailing Address - Street 1:24 CARE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124
Mailing Address - Country:US
Mailing Address - Phone:806-353-6100
Mailing Address - Fax:806-353-3372
Practice Address - Street 1:24 CARE CIRCLE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124
Practice Address - Country:US
Practice Address - Phone:806-353-6100
Practice Address - Fax:806-350-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102314OtherPTAN
TXE02183Medicare UPIN
TXE48592Medicare UPIN