1013981182 NPI number — AUSTIN DIAGNOSTIC CLINIC, PA

Table of content: (NPI 1013981182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013981182 NPI number — AUSTIN DIAGNOSTIC CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN DIAGNOSTIC CLINIC, 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:
Provider Other Organization Name Type Code:
6
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:
1013981182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12221 MO PAC EXPWY NORTH
Provider Second Line Business Mailing Address:
DEPT OF PHYSICAL THERAPY
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78758-2483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-901-4402
Provider Business Mailing Address Fax Number:
512-901-4103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12221 MO PAC EXPWY NORTH
Provider Second Line Business Practice Location Address:
DEPT OF PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-2483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-901-4402
Provider Business Practice Location Address Fax Number:
512-901-4103
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREW
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
512-901-4937

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140347946 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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