Provider Demographics
NPI:1245266790
Name:ABILENE SPINE & JOINT SURGERY CENTER LLC
Entity type:Organization
Organization Name:ABILENE SPINE & JOINT SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-245-9175
Mailing Address - Street 1:PO BOX 11538
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1538
Mailing Address - Country:US
Mailing Address - Phone:254-245-9177
Mailing Address - Fax:254-245-9178
Practice Address - Street 1:4351 RIDGEMONT DR STE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8747
Practice Address - Country:US
Practice Address - Phone:254-245-9175
Practice Address - Fax:254-213-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007117261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087968601Medicaid
TX181454800OtherACS TX DEPARTMENT LABOR
TXHH1515OtherBCBS
TX181454800OtherACS TX DEPARTMENT LABOR
TX087968601Medicaid
TX087968601Medicaid
TX181454800OtherACS TX DEPARTMENT LABOR