MEDICARE: AUSTIN INFECTIOUS DISEASE CONSULTANTS, PA 080191

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00F59E	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1205947710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN INFECTIOUS DISEASE CONSULTANTS, PA 080191

Provider Business Mailing Address
First Line	:	1301 W 38TH ST
Second Line	:	STE 403
City	:	AUSTIN
State	:	TX
Zip	:	78705-1000
Country	:	US
Telephone Number	:	512-459-0301
Fax Number	:	512-459-9701

Provider Business Practice Location Address
First Line	:	1301 W 38TH ST STE 403
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1013
Country	:	US
Telephone Number	:	512-459-0301
Fax Number	:	512-459-9701

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ARIANA MARES
Credential	:	CMM
Telephone Number	:	512-593-7902

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/09/2021

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