Healthcare Provider Details

I. General information

NPI: 1508131582
Provider Name (Legal Business Name): JAMES ROBERT CONWELL ATP, SMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES ROBERT CONWELL ATP, CRTS

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 METRIC BLVD STE A
AUSTIN TX
78758-4097
US

IV. Provider business mailing address

11110 METRIC BLVD STE A
AUSTIN TX
78758-4097
US

V. Phone/Fax

Practice location:
  • Phone: 737-343-2424
  • Fax:
Mailing address:
  • Phone: 512-738-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number247200000X
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: