Healthcare Provider Details

I. General information

NPI: 1497798193
Provider Name (Legal Business Name): AUSTIN NEPHROLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NORTH IH 35 SUITE 635
AUSTIN TX
78705-1804
US

IV. Provider business mailing address

8140 N MOPAC EXPY BUILDING II, SUITE 150
AUSTIN TX
78759-8860
US

V. Phone/Fax

Practice location:
  • Phone: 512-320-1500
  • Fax: 512-320-1588
Mailing address:
  • Phone: 512-382-0037
  • Fax: 512-382-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER L MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 512-382-0037