Provider Demographics
NPI:1336562214
Name:SPRING SPINE AND WELLNESS, PA
Entity Type:Organization
Organization Name:SPRING SPINE AND WELLNESS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-324-5385
Mailing Address - Street 1:26400 KUYKENDAHL RD
Mailing Address - Street 2:SUITE C-180-240
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77375
Mailing Address - Country:US
Mailing Address - Phone:832-324-5385
Mailing Address - Fax:
Practice Address - Street 1:19510 KUYKENDAHL RD SUITE A
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:832-324-5385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162393Medicare PIN