Provider Demographics
NPI:1245444744
Name:CAPITAL NEUROSURGICAL ASSOCIATION
Entity type:Organization
Organization Name:CAPITAL NEUROSURGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUEBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-9627
Mailing Address - Street 1:711 WEST 38TH ST
Mailing Address - Street 2:STE D-4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-454-9627
Mailing Address - Fax:512-454-6310
Practice Address - Street 1:711 WEST 38TH ST
Practice Address - Street 2:STE D-4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-454-9627
Practice Address - Fax:512-454-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0073207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093896101Medicaid
TX00GT80Medicare PIN
TX093896101Medicaid
TX1245444744Medicare NSC