Healthcare Provider Details

I. General information

NPI: 1487890620
Provider Name (Legal Business Name): AUSTIN VASCULAR INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 NORTH MOPAC EXPRESSWAY SUITE 320
AUSTIN TX
78731-3258
US

IV. Provider business mailing address

7000 NORTH MOPAC EXPRESSWAY SUITE 320
AUSTIN TX
78731-3258
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-8346
  • Fax: 512-346-8343
Mailing address:
  • Phone: 512-346-8346
  • Fax: 512-346-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: CHRISTOPHER BRENNIG
Title or Position: OWNER
Credential: MD
Phone: 512-346-8346