Healthcare Provider Details

I. General information

NPI: 1790702553
Provider Name (Legal Business Name): CENTRAL TEXAS SPINE INSTITUTE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 BEE CAVES RD SUITE 201
AUSTIN TX
78774-5550
US

IV. Provider business mailing address

3003 BEE CAVES RD SUITE 201
AUSTIN TX
78774-5550
US

V. Phone/Fax

Practice location:
  • Phone: 512-795-2225
  • Fax: 512-795-0701
Mailing address:
  • Phone: 512-795-2225
  • Fax: 512-795-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberH7390
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberD5229
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG4110
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG5625
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberK3624
License Number StateTX

VIII. Authorized Official

Name: MR. JESSICA AGNEW
Title or Position: BUSINESS MANAGER
Credential:
Phone: 512-795-2225