Provider Demographics
NPI:1457190456
Name:THE ORTHO SPINE CLINIC
Entity type:Organization
Organization Name:THE ORTHO SPINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VORANART
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUNAKAPADEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-597-8007
Mailing Address - Street 1:4020 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6419
Mailing Address - Country:US
Mailing Address - Phone:817-874-0926
Mailing Address - Fax:
Practice Address - Street 1:13112 HWY 110 S
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-6350
Practice Address - Country:US
Practice Address - Phone:903-521-0824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty