Provider Demographics
NPI:1144294661
Name:CENTRAL TEXAS PEDIATRIC ORTHOPEDICS AND SCOLIOSIS SURGERY PA
Entity type:Organization
Organization Name:CENTRAL TEXAS PEDIATRIC ORTHOPEDICS AND SCOLIOSIS SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. PARTNER AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-478-8116
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-478-8116
Mailing Address - Fax:512-478-9368
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-478-8116
Practice Address - Fax:512-478-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8973207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162421504OtherMEDICAID CSHCN
TX00N43XOtherBCBS GROUP #
TX1624215-03Medicaid
TX1624215-03Medicaid