MEDICARE: SPINEAUSTIN 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	207XS0117X	Orthopaedic Surgery of the Spine Physician
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1164530390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINEAUSTIN PA

Provider Business Mailing Address
First Line	:	3001 BEE CAVES RD
Second Line	:	STE 200
City	:	AUSTIN
State	:	TX
Zip	:	78746-5590
Country	:	US
Telephone Number	:	512-454-1234
Fax Number	:	512-472-7350

Provider Business Practice Location Address
First Line	:	3001 BEE CAVE RD STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-5590
Country	:	US
Telephone Number	:	512-454-1234
Fax Number	:	512-472-7350

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KURT VONRUEDEN
Credential	:	M.D.
Telephone Number	:	512-454-1234

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	02/16/2011

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Directions to “SPINEAUSTIN PA ” Practice Location

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