Provider Demographics
NPI:1174750236
Name:SPINE MEDICINE ASSOCIATES
Entity type:Organization
Organization Name:SPINE MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-453-8551
Mailing Address - Street 1:5225 KATY FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2211
Mailing Address - Country:US
Mailing Address - Phone:713-453-8551
Mailing Address - Fax:832-200-7131
Practice Address - Street 1:5225 KATY FWY STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2211
Practice Address - Country:US
Practice Address - Phone:713-453-8551
Practice Address - Fax:832-200-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center