Provider Demographics
NPI:1669769055
Name:PERFORMANCE SPINE AND SPORTS MEDICINE
Entity type:Organization
Organization Name:PERFORMANCE SPINE AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANCHERLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-327-8800
Mailing Address - Street 1:4613 BEE CAVE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5206
Mailing Address - Country:US
Mailing Address - Phone:512-327-8800
Mailing Address - Fax:512-327-8802
Practice Address - Street 1:4613 BEE CAVE RD STE 105
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5206
Practice Address - Country:US
Practice Address - Phone:512-327-8800
Practice Address - Fax:512-327-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM62182081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty