Basic Information
| Provider Information | |||||||||
| NPI: | 1700014826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRISCO SPINE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6020 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750350225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145062610 | ||||||||
| FaxNumber: | 9726818727 | ||||||||
| Practice Location | |||||||||
| Address1: | 8350 DALLAS PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750345076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723779200 | ||||||||
| FaxNumber: | 9723779300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | PALACIOS | ||||||||
| AuthorizedOfficialFirstName: | BRISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4692948926 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 207T00000X | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.