1073652012 NPI number — MEC ASSOCIATES OF AUSTIN, L.L.P.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073652012 NPI number — MEC ASSOCIATES OF AUSTIN, L.L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEC ASSOCIATES OF AUSTIN, L.L.P.
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:
PRO MED MEDICAL CARE CENTERS
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:
1073652012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 S LAMAR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-7943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-444-6824
Provider Business Mailing Address Fax Number:
512-444-6852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 S LAMAR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-444-6824
Provider Business Practice Location Address Fax Number:
512-444-6852
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMOLIK
Authorized Official First Name:
E
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
512-444-6824

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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