Provider Demographics
NPI:1881124550
Name:TEXAS HEALTH SPINE SURGERY CENTER ALLEN, LLC
Entity type:Organization
Organization Name:TEXAS HEALTH SPINE SURGERY CENTER ALLEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GATLEY
Authorized Official - Last Name:HEBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-442-9300
Mailing Address - Street 1:1340 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5547
Mailing Address - Country:US
Mailing Address - Phone:682-651-1908
Mailing Address - Fax:682-651-1925
Practice Address - Street 1:1120 RAINTREE CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:817-442-9300
Practice Address - Fax:682-651-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical