Provider Demographics
NPI:1497412290
Name:VIRTUOSO SPINE AND JOINT CARROLLTON PLLC
Entity type:Organization
Organization Name:VIRTUOSO SPINE AND JOINT CARROLLTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:SURESH
Authorized Official - Last Name:CHAVDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-883-8303
Mailing Address - Street 1:P O BOX 650444, DEPT 137
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4323 N JOSEY LN STE 206
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4630
Practice Address - Country:US
Practice Address - Phone:214-774-4878
Practice Address - Fax:213-444-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty