1366015794 NPI number — ASCEND MEDICAL AUSTIN TEXAS, PA

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 1366015794 NPI number — ASCEND MEDICAL AUSTIN TEXAS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCEND MEDICAL AUSTIN TEXAS, 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:
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:
1366015794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3560 LENOX RD NE STE 1230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30326-4335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-250-5708
Provider Business Mailing Address Fax Number:
470-276-7133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 LAS CIMAS PKWY STE 130
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:
78746-6527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-956-2132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
404-998-8645

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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