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:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-795-2225
Mailing Address - Street 1:3003 BEE CAVES RD SUITE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78774-5550
Mailing Address - Country:US
Mailing Address - Phone:512-795-2225
Mailing Address - Fax:512-795-0701
Practice Address - Street 1:3003 BEE CAVES RD SUITE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78774-5550
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:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4110207XS0117X
TXK3624207XS0117X
TXH7390207LP2900X
TXD5229207XS0117X
TXG5625207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083818701Medicaid