Provider Demographics
NPI:1942292255
Name:TEXAS SPINE AND JOINT HOSPITAL, LLC
Entity Type:Organization
Organization Name:TEXAS SPINE AND JOINT HOSPITAL, LLC
Other - Org Name:BAYLOR SCOTT & WHITE TX SPINE & JOINT HOS SUR CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-525-3329
Mailing Address - Street 1:1814 ROSELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4262
Mailing Address - Country:US
Mailing Address - Phone:903-525-3300
Mailing Address - Fax:903-525-3397
Practice Address - Street 1:1814 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4262
Practice Address - Country:US
Practice Address - Phone:903-525-3300
Practice Address - Fax:903-525-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007902282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162459502Medicaid
TX162459501Medicaid
TXHH1021OtherBCBS
TX162459502Medicaid