1659349009 NPI number — AUSTIN OTOLOGY ASSOCIATES PA

Table of content: (NPI 1659349009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659349009 NPI number — AUSTIN OTOLOGY ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN OTOLOGY ASSOCIATES PA
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 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:
1659349009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12319 N MOPAC EXPY
Provider Second Line Business Mailing Address:
BLDG C, SUITE 300
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78758-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-454-0341
Provider Business Mailing Address Fax Number:
512-454-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12319 N MOPAC EXPY
Provider Second Line Business Practice Location Address:
BLDG C, SUITE 300
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-454-0341
Provider Business Practice Location Address Fax Number:
512-454-9915
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLATER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
512-454-0341

Provider Taxonomy Codes

  • Taxonomy code: 207YX0901X , with the licence number:  K5006 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780691030 . This is a "ERIN REHBERG IND. NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0010CP . This is a "BCBS GROUP#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 047540201 . This is a "MEDICAID IND. TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1942201579 . This is a "KRISTIN ARMSTRONG IND. NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 079793801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1467440180 . This is a "SLATER IND. NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1821275504 . This is a "AMY GENSLER IND. NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87991G . This is a "BSBC SLATER IND#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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