Healthcare Provider Details

I. General information

NPI: 1144265000
Provider Name (Legal Business Name): AUSTIN MEDICAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N FIESTA BLVD SUITE 3
GILBERT AZ
85233-1609
US

IV. Provider business mailing address

PO BOX 54811
PHOENIX AZ
85078-4811
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JILL SUZANNE AUSTIN
Title or Position: OWNER
Credential: PA-C
Phone: 602-418-0961