1457344780 NPI number — BILLIE KAREN MARTIN PA

Table of content: BILLIE KAREN MARTIN PA (NPI 1457344780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457344780 NPI number — BILLIE KAREN MARTIN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
BILLIE
Provider Middle Name:
KAREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1457344780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AUSTIN HEART PLLC
Provider Second Line Business Mailing Address:
PO BOX 402669
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-2669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-206-4300
Provider Business Mailing Address Fax Number:
512-206-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 WONDER WORLD DR
Provider Second Line Business Practice Location Address:
STE B108
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666-7566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-396-5603
Provider Business Practice Location Address Fax Number:
512-396-5623
Provider Enumeration Date:
08/23/2005

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:  PA00781 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA00781 , 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: 1961021-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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