Provider Demographics
NPI:1164530390
Name:SPINEAUSTIN PA
Entity Type:Organization
Organization Name:SPINEAUSTIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:VONRUEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-454-1234
Mailing Address - Street 1:3001 BEE CAVES RD
Mailing Address - Street 2:STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5590
Mailing Address - Country:US
Mailing Address - Phone:512-454-1234
Mailing Address - Fax:512-472-7350
Practice Address - Street 1:3001 BEE CAVE RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5590
Practice Address - Country:US
Practice Address - Phone:512-454-1234
Practice Address - Fax:512-472-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTSX01Medicare PIN
TX5522360001Medicare NSC