Provider Demographics
NPI:1881854313
Name:TOLLROAD SPINE INSTITUTE PAIN CENTER, LLC
Entity Type:Organization
Organization Name:TOLLROAD SPINE INSTITUTE PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-479-1115
Mailing Address - Street 1:PO BOX 268866
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8866
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-346-8013
Practice Address - Street 1:17110 DALLAS PKWY STE 125
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1181
Practice Address - Country:US
Practice Address - Phone:972-479-1115
Practice Address - Fax:972-346-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical