Provider Demographics
NPI:1740314780
Name:INNOVATIVE BACK CARE CENTER, LP
Entity type:Organization
Organization Name:INNOVATIVE BACK CARE CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-817-2113
Mailing Address - Street 1:715 GARRETT WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5086
Mailing Address - Country:US
Mailing Address - Phone:281-565-1922
Mailing Address - Fax:
Practice Address - Street 1:6350 HIGHWAY 90A
Practice Address - Street 2:SUITE 700
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2021
Practice Address - Country:US
Practice Address - Phone:713-817-2113
Practice Address - Fax:281-565-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical