Provider Demographics
NPI:1518126093
Name:CENTRAL TEXAS NEUROSURGERY FOR CHILDREN
Entity Type:Organization
Organization Name:CENTRAL TEXAS NEUROSURGERY FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-7740
Mailing Address - Street 1:1106 CLAYTON LN
Mailing Address - Street 2:STE. 200W
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1066
Mailing Address - Country:US
Mailing Address - Phone:512-371-7740
Mailing Address - Fax:512-371-7759
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:STE. 200W
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1066
Practice Address - Country:US
Practice Address - Phone:512-371-7740
Practice Address - Fax:512-371-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3069207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090005203Medicaid
TX090005203Medicaid
00573MMedicare PIN