1679703698 NPI number — AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA

Table of content: (NPI 1679703698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679703698 NPI number — AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA
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:
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:
1679703698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3724 EXECUTIVE CENTER DR STE G10
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:
78731-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-345-5925
Provider Business Mailing Address Fax Number:
512-343-7113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 W SLAUGHTER LN
Provider Second Line Business Practice Location Address:
BLDG 6, STE 100
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78749-3997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-345-5925
Provider Business Practice Location Address Fax Number:
512-343-7113
Provider Enumeration Date:
07/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-345-5925

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 085111501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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