# SPINE INFORMATICS AUSTIN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417476912
- **Authorized official:** MR. GERALD LEE DEVRIES JR. INVESTOR (GENERAL MANAGER)
- **Authorized official phone:** (512) 913-1834

## Contact information

- **Practice address:** 110 WILD BASIN RD STE 250, WEST LAKE HILLS, TX 78746-3352
- **Practice address phone:** (512) 531-9912
- **Practice address fax:** (512) 537-1537
- **Mailing address:** 3202 SWEET AUTUMN CV, AUSTIN, TX 78735-1524
- **Mailing address phone:** (512) 913-1834
- **Mailing address fax:** (512) 537-1537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 09/15/2017
- **Last updated:** 09/15/2017