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General NPI Number Information
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NPI Number | 1659919546
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Entity Type | Organization
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Legal Business Name | AUSTIN INTEGRATIVE SPINE, PLLC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 5656 BEE CAVES ROAD SUITE C-101
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City | AUSTIN
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State | TX
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Zip | 78746
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Country | US
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Telephone | 512-212-4865
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Fax | 737-220-2520
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Provider Business Mailing Address
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Address Line | 2510 TRAIL OF THE MADRONES
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City | AUSTIN
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State | TX
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Zip | 78746-2341
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Country | US
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Telephone | 512-212-4865
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Fax | 737-220-2520
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Authorized Official
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Title or Position | NEUROSURGEON
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Name | MARCELLA MADERA
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Credential | MD
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Telephone | 512-212-4865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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