Provider Demographics
NPI:1790718146
Name:CENTRAL TEXAS NEUROLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:CENTRAL TEXAS NEUROLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:512-218-1222
Mailing Address - Street 1:16040 PARK VALLEY DRIVE
Mailing Address - Street 2:BUILDING B SUITE 100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3573
Mailing Address - Country:US
Mailing Address - Phone:512-218-1222
Mailing Address - Fax:512-218-1393
Practice Address - Street 1:16040 PARK VALLEY DR
Practice Address - Street 2:BLDG B, SUITE 100
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-218-1222
Practice Address - Fax:512-218-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TX661480000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000N75F6Medicaid
TXZ000N75F6Medicaid