1447538806 NPI number — CENTEX SPINE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447538806 NPI number — CENTEX SPINE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTEX SPINE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AUSTIN PREFERRED SPINE AND SPORTS REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447538806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78763-5927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-442-2727
Provider Business Mailing Address Fax Number:
512-442-2728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4316 JAMES CASEY ST
Provider Second Line Business Practice Location Address:
BLDG B, SUITE 201
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78745-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-442-2727
Provider Business Practice Location Address Fax Number:
512-442-2728
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FLUITT
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-442-2727

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8815 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0052WV . This is a "BCBS GROUP PROVIDER RECORD ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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