Healthcare Provider Details

I. General information

NPI: 1295848257
Provider Name (Legal Business Name): AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 EXECUTIVE CENTER DR STE G10
AUSTIN TX
78731-1665
US

IV. Provider business mailing address

3724 EXECUTIVE CENTER DR STE G10
AUSTIN TX
78731-1665
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-5925
  • Fax: 512-343-7113
Mailing address:
  • Phone: 512-345-5925
  • Fax: 512-343-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04626
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05193
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberH2134
License Number StateTX

VIII. Authorized Official

Name: DR. JAMES E HANSEN
Title or Position: PRESIDENT
Credential: MD
Phone: 512-345-5925