Provider Demographics
NPI:1396950895
Name:TEXAS INSTITUTE FOR SPINE PAIN & REHABILITATION, P.A.
Entity type:Organization
Organization Name:TEXAS INSTITUTE FOR SPINE PAIN & REHABILITATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINKER
Authorized Official - Middle Name:G
Authorized Official - Last Name:AMATYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-773-4348
Mailing Address - Street 1:6776 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2107
Mailing Address - Country:US
Mailing Address - Phone:713-773-4348
Mailing Address - Fax:713-773-1948
Practice Address - Street 1:TOWN PARK SURGERY CENTER
Practice Address - Street 2:9901 TOWN PARK DR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-773-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00762YMedicare PIN