Provider Demographics
NPI:1295848257
Name:AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA
Entity Type:Organization
Organization Name:AUSTIN NEUROSURGICAL AND SPINE INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-345-5925
Mailing Address - Street 1:3724 EXECUTIVE CENTER DR STE G10
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1665
Mailing Address - Country:US
Mailing Address - Phone:512-345-5925
Mailing Address - Fax:512-343-7113
Practice Address - Street 1:3724 EXECUTIVE CENTER DR STE G10
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1665
Practice Address - Country:US
Practice Address - Phone:512-345-5925
Practice Address - Fax:512-343-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2134207T00000X
TXPA04626363A00000X
TXPA05193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085111501Medicaid
TXMDH2134OtherWORKERS COMPENSATION
TX00T05KMedicare ID - Type Unspecified
TX085111501Medicaid