Healthcare Provider Details

I. General information

NPI: 1659919546
Provider Name (Legal Business Name): AUSTIN INTEGRATIVE SPINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 BEE CAVES ROAD SUITE C-101
AUSTIN TX
78746
US

IV. Provider business mailing address

2510 TRAIL OF THE MADRONES
AUSTIN TX
78746-2341
US

V. Phone/Fax

Practice location:
  • Phone: 512-212-4865
  • Fax: 737-220-2520
Mailing address:
  • Phone: 512-212-4865
  • Fax: 737-220-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA MADERA
Title or Position: NEUROSURGEON
Credential: MD
Phone: 512-212-4865