Provider Demographics
NPI:1255674867
Name:REGENERATIVE ORTHO SPINE INSTITUTE OF TEXAS P.A.
Entity type:Organization
Organization Name:REGENERATIVE ORTHO SPINE INSTITUTE OF TEXAS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-682-3909
Mailing Address - Street 1:PO BOX 141166
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1166
Mailing Address - Country:US
Mailing Address - Phone:972-682-3909
Mailing Address - Fax:
Practice Address - Street 1:2692 N GALLOWAY AVE
Practice Address - Street 2:STE 402
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6360
Practice Address - Country:US
Practice Address - Phone:972-682-3909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty