Provider Demographics
NPI:1043405780
Name:ANANT I PATEL, MD PA
Entity Type:Organization
Organization Name:ANANT I PATEL, MD PA
Other - Org Name:CENTRAL TEXAS BRAIN AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESS
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-837-7999
Mailing Address - Street 1:12180 N MOPAC EXPY
Mailing Address - Street 2:STE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2909
Mailing Address - Country:US
Mailing Address - Phone:512-617-6767
Mailing Address - Fax:512-617-5598
Practice Address - Street 1:12180 N MOPAC EXPY
Practice Address - Street 2:STE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2909
Practice Address - Country:US
Practice Address - Phone:512-617-2810
Practice Address - Fax:512-814-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4982207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179612001Medicaid
TX179612001Medicaid