1932136256 NPI number — SOUTH AUSTIN REHABILITATION & WOUND CLINIC INC

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 1932136256 NPI number — SOUTH AUSTIN REHABILITATION & WOUND CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH AUSTIN REHABILITATION & WOUND CLINIC INC
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:
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:
1932136256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 W BEN WHITE BLVD
Provider Second Line Business Mailing Address:
SUITE 100B
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-7667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-440-1441
Provider Business Mailing Address Fax Number:
512-440-1448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 W BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
SUITE 100B
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-440-1441
Provider Business Practice Location Address Fax Number:
512-440-1448
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
512-440-1441

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , 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: 0068KK . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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