Provider Demographics
NPI:1750637997
Name:LASER SPINE OF SAN ANTONIO PLLC
Entity type:Organization
Organization Name:LASER SPINE OF SAN ANTONIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-545-0087
Mailing Address - Street 1:20079 STONE OAK PKWY
Mailing Address - Street 2:1105-446
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6942
Mailing Address - Country:US
Mailing Address - Phone:210-545-0087
Mailing Address - Fax:210-545-3455
Practice Address - Street 1:2116 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4411
Practice Address - Country:US
Practice Address - Phone:210-545-0087
Practice Address - Fax:210-545-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty