Healthcare Provider Details

I. General information

NPI: 1861815995
Provider Name (Legal Business Name): EHI AUSTIN CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 OAK CREEK DR SUITE 120
AUSTIN TX
78727-3020
US

IV. Provider business mailing address

3107 OAK CREEK DR SUITE 120
AUSTIN TX
78727-3020
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-7800
  • Fax:
Mailing address:
  • Phone: 512-244-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0554
License Number StateTX

VIII. Authorized Official

Name: CYNTHIA WINN
Title or Position: CEDENTIALING SPECIALIST
Credential:
Phone: 512-738-0428