1528236155 NPI number — HEALTHWORKS SPINE & SPORT, PLLC

Table of content: (NPI 1528236155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528236155 NPI number — HEALTHWORKS SPINE & SPORT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHWORKS SPINE & SPORT, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528236155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 TOVREA ROAD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ALVIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77511-2962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-286-2229
Provider Business Mailing Address Fax Number:
281-727-0453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 APOLLO LANE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058-2672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-286-2229
Provider Business Practice Location Address Fax Number:
281-727-0453
Provider Enumeration Date:
02/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
281-286-2229

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 8109 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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