1861417958 NPI number — DR. ANTHONY C CARUSO MD

Table of content: DR. ANTHONY C CARUSO MD (NPI 1861417958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861417958 NPI number — DR. ANTHONY C CARUSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARUSO
Provider First Name:
ANTHONY
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1861417958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6210 E HWY 290 STE 240
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:
78723-1144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-344-0450
Provider Business Mailing Address Fax Number:
512-406-7318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6818 AUSTIN CENTER BLVD STE 205
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:
78731-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-344-0450
Provider Business Practice Location Address Fax Number:
512-406-7318
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  T3597 , 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: 060023915 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 50747 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 522462 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 535920 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006022782 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0737590 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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