Organization
FORT WORTH BRAIN & SPINE INSTITUTE, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS S ELLIS MD (PRESIDENT)
(817) 878-5333
Entity
Organization
Contact information
Practice address
1900 MISTLETOE BLVD, SUITE 200, FORT WORTH, TX 76104-4014
(817) 878-5333
(817) 878-5334
Mailing address
1900 MISTLETOE BLVD, SUITE 200, FORT WORTH, TX 76104-4014
(817) 878-5333
(817) 878-5334
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
61650301
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158682801
TPI
TX
01
—
DA1062
RAILROAD MEDICARE
TX
Enumeration date
07/20/2006
Last updated
04/21/2014
Update your record
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