Healthcare Provider Details

I. General information

NPI: 1659708220
Provider Name (Legal Business Name): SOUTHWEST AUSTIN FOOT & ANKLE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 EIGER RD STE 110
AUSTIN TX
78735-8978
US

IV. Provider business mailing address

5625 EIGER RD STE 110
AUSTIN TX
78735-8978
US

V. Phone/Fax

Practice location:
  • Phone: 512-447-4122
  • Fax: 512-614-4139
Mailing address:
  • Phone: 512-447-4122
  • Fax: 512-614-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: VI H NGUYEN
Title or Position: OWNER
Credential: DPM
Phone: 512-447-4122