Basic Information
| Provider Information | |||||||||
| NPI: | 1245266790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABILENE SPINE & JOINT SURGERY CENTER PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11538 | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765471538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542459177 | ||||||||
| FaxNumber: | 2542459178 | ||||||||
| Practice Location | |||||||||
| Address1: | 4351 RIDGEMONT DR STE B | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796068747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257951888 | ||||||||
| FaxNumber: | 3257959537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | IRVINE | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2542459175 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 007117 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | ASC007117TX | 01 | TX | STATE LICENSE NUMBER | OTHER | 131376100 | 01 | TX | FIRSTCARE | OTHER | HH1515 | 01 | TX | BCBS | OTHER | 181454800 | 01 | TX | ACS TX DEPARTMENT LABOR | OTHER | 087968601 | 05 | TX | MEDICAID |