Provider Demographics
NPI:1891952495
Name:MAINLAND SPINE CENTER LLC
Entity Type:Organization
Organization Name:MAINLAND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPINE DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAQIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-315-8000
Mailing Address - Street 1:33300 EGYPT LN
Mailing Address - Street 2:SUITE F-200
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2739
Mailing Address - Country:US
Mailing Address - Phone:281-315-8000
Mailing Address - Fax:
Practice Address - Street 1:3750 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539
Practice Address - Country:US
Practice Address - Phone:713-357-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008379261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI35412Medicare UPIN