Provider Demographics
NPI:1790702553
Name:CENTRAL TEXAS SPINE INSTITUTE, LLP
Entity Type:Organization
Organization Name:CENTRAL TEXAS SPINE INSTITUTE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-795-2225
Mailing Address - Street 1:6818 AUSTIN CENTER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3100
Mailing Address - Country:US
Mailing Address - Phone:512-795-2225
Mailing Address - Fax:512-795-0701
Practice Address - Street 1:6818 AUSTIN CENTER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3100
Practice Address - Country:US
Practice Address - Phone:512-795-2225
Practice Address - Fax:512-795-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7390207LP2900X
TXD5229207XS0117X
TXG4110207XS0117X
TXG5625207XS0117X
TXK3624207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L71GMedicare ID - Type Unspecified