| Advanced Spine Solutions Pa | |
|
261 W Southlake Blvd Southlake TX 76092-7046 | |
| (817) 310-8783 | |
| (855) 640-3872 |
| Full Name | Advanced Spine Solutions Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 261 W Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Kevin B James (PHYSICIAN) |
| Authorized Official Contact | 8173108783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Spine Solutions Pa 2813 W Southlake Blvd Suite #100 Southlake TX 76092-6829 Ph: (817) 310-8783 | Advanced Spine Solutions Pa 261 W Southlake Blvd Southlake TX 76092-7046 Ph: (817) 310-8783 |
| NPI Number | 1235308578 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 09/19/2023 |
| Medicare PECOS PAC ID | 9739265539 |
|---|---|
| Medicare Enrollment ID | O20080319000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235308578 | NPI | - | NPPES |
| 194675801 | Medicaid | TX | |
| 0059QH | Other | TX | BCBS |
| 194675802 | Medicaid | TX | |
| 194675803 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | M4201 (Texas) | Primary |
| Provider Name | Kevin B James |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1669530267 PECOS PAC ID: 4284710088 Enrollment ID: I20080319000280 |
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