Provider Demographics
NPI:1235958760
Name:NORTH TEXAS BRAIN AND SPINE CENTER
Entity type:Organization
Organization Name:NORTH TEXAS BRAIN AND SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINDHEIM-GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-919-1043
Mailing Address - Street 1:4261 E UNIVERSITY DR # 30-276
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3645
Mailing Address - Country:US
Mailing Address - Phone:469-557-5434
Mailing Address - Fax:
Practice Address - Street 1:2381 E UNIVERSITY DR STE 50
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2390
Practice Address - Country:US
Practice Address - Phone:469-557-5434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty