1609065242 NPI number — BUTLER & BURNS EAR NOSE & THROAT

Table of content: (NPI 1609065242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609065242 NPI number — BUTLER & BURNS EAR NOSE & THROAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUTLER & BURNS EAR NOSE & THROAT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AUSTIN EAR NOSE & THROAT CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609065242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3705 MEDICAL PKWY
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-454-0392
Provider Business Mailing Address Fax Number:
512-454-6019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 HIGHWAY 71 W
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-454-0392
Provider Business Practice Location Address Fax Number:
512-454-6019
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WINEGAR
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
512-454-0392

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  K5842 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YS0123X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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