Provider Demographics
NPI:1811133259
Name:WEST TEXAS SPINE PA
Entity type:Organization
Organization Name:WEST TEXAS SPINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOGAN
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-580-5888
Mailing Address - Street 1:6010 E HIGHWAY 191
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5070
Mailing Address - Country:US
Mailing Address - Phone:432-580-5888
Mailing Address - Fax:432-580-5899
Practice Address - Street 1:6010 E HIGHWAY 191
Practice Address - Street 2:SUITE 125
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5070
Practice Address - Country:US
Practice Address - Phone:432-580-5888
Practice Address - Fax:432-580-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8732207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4752OtherMEDICARE ID-TYPE UNSPECIFIED
TX124591209Medicaid
TX138203812Medicaid
TXG19811Medicare UPIN
TX8K4731Medicare Oscar/Certification
TX138203812Medicaid
TX8F4752Medicare PIN
TX124591209Medicaid