Provider Demographics
NPI:1134587298
Name:TEXOMA BRAIN AND SPINE SURGERY PLLC
Entity type:Organization
Organization Name:TEXOMA BRAIN AND SPINE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOLLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-416-6460
Mailing Address - Street 1:5012 SOUTH US HWY 75
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4598
Mailing Address - Country:US
Mailing Address - Phone:903-416-6460
Mailing Address - Fax:
Practice Address - Street 1:5012 SOUTH US HWY 75
Practice Address - Street 2:SUITE 220
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4598
Practice Address - Country:US
Practice Address - Phone:903-416-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4930207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty