MEDICARE: AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA

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	363A00000X	Physician Assistant
2	207T00000X	Neurological Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407084858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA

Provider Business Mailing Address
First Line	:	3724 EXECUTIVE CENTER DR STE G10
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-1665
Country	:	US
Telephone Number	:	512-376-5247
Fax Number	:	512-376-6252

Provider Business Practice Location Address
First Line	:	1009 W SAN ANTONIO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-2421
Country	:	US
Telephone Number	:	512-345-5925
Fax Number	:	512-343-7113

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES E HANSEN
Credential	:	MD
Telephone Number	:	512-376-5247

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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Directions to “AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA ” Practice Location

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