1770104481 NPI number — SATELLITE HEALTHCARE OF AUSTIN LLC

Table of content: (NPI 1770104481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770104481 NPI number — SATELLITE HEALTHCARE OF AUSTIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SATELLITE HEALTHCARE OF AUSTIN LLC
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:
1770104481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SANTANA ROW STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-404-3655
Provider Business Mailing Address Fax Number:
650-625-6007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10001 S IH 35 STE 100
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:
78747-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-282-8500
Provider Business Practice Location Address Fax Number:
512-280-2963
Provider Enumeration Date:
05/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL - PRESIDENT & C
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110580 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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