Provider Demographics
NPI:1659919546
Name:AUSTIN INTEGRATIVE SPINE, PLLC
Entity Type:Organization
Organization Name:AUSTIN INTEGRATIVE SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-212-4865
Mailing Address - Street 1:2510 TRAIL OF THE MADRONES
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2341
Mailing Address - Country:US
Mailing Address - Phone:512-212-4865
Mailing Address - Fax:737-220-2520
Practice Address - Street 1:5656 BEE CAVES ROAD
Practice Address - Street 2:SUITE C-101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-212-4865
Practice Address - Fax:737-220-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty