# SPINE MINIVASIVE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336492487
- **Authorized official:** PHILLIP C PHAN MD (OWNER)
- **Authorized official phone:** (888) 959-7088

## Contact information

- **Practice address:** 2646 S LOOP W, 360, HOUSTON, TX 77054-2665
- **Practice address phone:** (888) 959-7088
- **Mailing address:** 2646 S LOOP W, 360, HOUSTON, TX 77054-2665
- **Mailing address phone:** (888) 959-7088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 10/25/2012
- **Last updated:** 10/25/2012