Healthcare Provider Details

I. General information

NPI: 1437563582
Provider Name (Legal Business Name): UTC PROVIDERS - AUSTIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SHOAL CREEK BLVD STE 200
AUSTIN TX
78757-6853
US

IV. Provider business mailing address

8900 SHOAL CREEK BLVD STE 300
AUSTIN TX
78757-6853
US

V. Phone/Fax

Practice location:
  • Phone: 512-323-6900
  • Fax: 512-375-3865
Mailing address:
  • Phone: 512-323-6900
  • Fax: 512-375-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: NATHALIE BLACKSTOCK
Title or Position: EXECUTIVE DIRECTOR, RCM DIVISION
Credential:
Phone: 512-323-6900