Basic Information
| Provider Information | |||||||||
| NPI: | 1467977934 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS SPINE SOLUTION PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 41 | ||||||||
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| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473080041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652840493 | ||||||||
| FaxNumber: | 7652842434 | ||||||||
| Practice Location | |||||||||
| Address1: | 5575 WARREN PKWY STE 314 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750344092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724994280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | BANISTER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8066839251 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.