MEDICARE: PREFERRED SPINE AND PAIN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1104258565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED SPINE AND PAIN PLLC

Provider Business Mailing Address
First Line	:	12319 N MOPAC EXPY
Second Line	:	SUITE 350
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12319 N MOPAC EXPY
Second Line	:	SUITE 350
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:	512-255-7246
Fax Number	:	512-255-7547

Authorized Official
Title or Position	:	DO
Name	:	MATTHEW KAPLAN
Credential	:
Telephone Number	:	512-255-7246

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	10/13/2014

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