1528134228 NPI number — NEUROSURGICAL SPECIALISTS OF AUSTIN, P.A.

Table of content: (NPI 1528134228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528134228 NPI number — NEUROSURGICAL SPECIALISTS OF AUSTIN, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSURGICAL SPECIALISTS OF AUSTIN, P.A.
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:
Provider Other Organization Name Type Code:
6
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:
1528134228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 W 38TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-306-1323
Provider Business Mailing Address Fax Number:
512-306-1142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W 38TH ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-306-1323
Provider Business Practice Location Address Fax Number:
512-306-1142
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
512-306-1323

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0095BY . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112888602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: C14571 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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