1437493244 NPI number — INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY OF CENTRAL TEXAS

Table of content: (NPI 1437493244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437493244 NPI number — INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY OF CENTRAL TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY OF CENTRAL TEXAS
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:
1437493244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N IH 35
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-324-8320
Provider Business Mailing Address Fax Number:
512-324-8326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 SETON PKWY
Provider Second Line Business Practice Location Address:
STE 402
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78665-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-4815
Provider Business Practice Location Address Fax Number:
512-324-4726
Provider Enumeration Date:
11/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PADILLA
Authorized Official First Name:
JAMINE
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
SR DEPT ASSISTANT
Authorized Official Telephone Number:
512-324-8320

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0105X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 203606301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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