Healthcare Provider Details

I. General information

NPI: 1588638548
Provider Name (Legal Business Name): AUSTIN DIAGNOSTIC CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 MOPAC EXPRESSWAY N DEPT OF ORTHOPAEDIC SURGERY
AUSTIN TX
78758-2483
US

IV. Provider business mailing address

12221 MOPAC EXPRESSWAY N DEPT OF ORTHOPAEDIC SURGERY
AUSTIN TX
78758-2483
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4015
  • Fax: 512-901-3915
Mailing address:
  • Phone: 512-901-4015
  • Fax: 512-901-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLEN M ANDREW
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 512-901-4937