Provider Demographics
NPI:1982927265
Name:SOUTH TEXAS SPINE GROUP PC
Entity Type:Organization
Organization Name:SOUTH TEXAS SPINE GROUP PC
Other - Org Name:A TO Z MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, DC
Authorized Official - Phone:956-244-4041
Mailing Address - Street 1:7097 N EXPY 77
Mailing Address - Street 2:STE 5
Mailing Address - City:OLMITO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9807
Mailing Address - Country:US
Mailing Address - Phone:956-518-7305
Mailing Address - Fax:956-518-7307
Practice Address - Street 1:7097 N EXPY 77
Practice Address - Street 2:STE 5
Practice Address - City:OLMITO
Practice Address - State:TX
Practice Address - Zip Code:78575-9807
Practice Address - Country:US
Practice Address - Phone:956-518-7305
Practice Address - Fax:956-518-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6041111N00000X
TX776890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty