Provider Demographics
NPI:1649483900
Name:NEUROLOGIC & SPINE INSTITUTE OF N.TX., PA
Entity type:Organization
Organization Name:NEUROLOGIC & SPINE INSTITUTE OF N.TX., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-893-5177
Mailing Address - Street 1:PO BOX 2432
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2432
Mailing Address - Country:US
Mailing Address - Phone:903-893-5177
Mailing Address - Fax:903-813-0210
Practice Address - Street 1:300 N HIGHLAND AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7388
Practice Address - Country:US
Practice Address - Phone:903-893-5177
Practice Address - Fax:903-813-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK45072084N0400X
TX1152290225100000X
TX257405363LA2100X
TX7071111N00000X
TXH0737207T00000X
TXH6527207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1992747638OtherNPI NUMBER
TX1689686461OtherNPI NUMBER
TX1588625263OtherNPI NUMBER
TX1922042951OtherNPI NUMBER
TX1245276500OtherNPI NUMBER
TX1710923388OtherNPI NUMBER