Healthcare Provider Details

I. General information

NPI: 1073702981
Provider Name (Legal Business Name): AUSTIN CHILDREN'S CHEST ASSOCIATES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 NORTHLAND DR STE 512
AUSTIN TX
78731-4991
US

IV. Provider business mailing address

3305 NORTHLAND DR STE 512
AUSTIN TX
78731-4991
US

V. Phone/Fax

Practice location:
  • Phone: 512-380-9200
  • Fax: 512-380-9201
Mailing address:
  • Phone: 512-380-9200
  • Fax: 512-380-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: GINGER DOUGLAS
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 512-380-3800