Healthcare Provider Details

I. General information

NPI: 1366981607
Provider Name (Legal Business Name): HEALTHRECLAIMED CENTER OF AUSTIN, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 EXECUTIVE CENTER DR SUITE 211
AUSTIN TX
78731-1644
US

IV. Provider business mailing address

3701 EXECUTIVE CENTER DR 211
AUSTIN TX
78731-1644
US

V. Phone/Fax

Practice location:
  • Phone: 512-672-8797
  • Fax:
Mailing address:
  • Phone: 512-672-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberK9375
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberK9375
License Number StateTX

VIII. Authorized Official

Name: DR. PHYLLIS CHIZOMAM OKEREKE
Title or Position: PRESIDENT
Credential: MD
Phone: 512-672-8797