Healthcare Provider Details

I. General information

NPI: 1255395810
Provider Name (Legal Business Name): HURT, JACKNOW, MOORE, CONNOR, WELLS, MICHELS, YURCO, LISTROM & HUANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 EXECUTIVE CENTER DR STE 250
AUSTIN TX
78731
US

IV. Provider business mailing address

PO BOX 28770
AUSTIN TX
78755
US

V. Phone/Fax

Practice location:
  • Phone: 512-579-4000
  • Fax: 512-439-2814
Mailing address:
  • Phone: 512-579-4000
  • Fax: 512-439-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number00RM54
License Number StateTX

VIII. Authorized Official

Name: JACQUELINE J HAAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 512-579-4000