Healthcare Provider Details

I. General information

NPI: 1962186437
Provider Name (Legal Business Name): MANN AUSTIN SURGERY SUITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 W BRAKER LN FL 2
AUSTIN TX
78759-5358
US

IV. Provider business mailing address

4314 W BRAKER LN FL 2
AUSTIN TX
78759-5358
US

V. Phone/Fax

Practice location:
  • Phone: 800-698-4746
  • Fax:
Mailing address:
  • Phone: 800-698-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL MICHAEL MANN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 800-698-4746