Provider Demographics
NPI:1497283048
Name:SPINETECH SURGERY CENTER LLC
Entity type:Organization
Organization Name:SPINETECH SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-234-7088
Mailing Address - Street 1:755 S 11TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3723
Mailing Address - Country:US
Mailing Address - Phone:409-892-8237
Mailing Address - Fax:409-898-0177
Practice Address - Street 1:950 N 11TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1203
Practice Address - Country:US
Practice Address - Phone:409-833-0193
Practice Address - Fax:844-873-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty