Healthcare Provider Details

I. General information

NPI: 1659522373
Provider Name (Legal Business Name): AUSTIN IMMEDIATE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W SLAUGHTER LN BLDG. 6, SUITE 100
AUSTIN TX
78749-3997
US

IV. Provider business mailing address

1 JOHN JAMES AUDUBON PKWY
AMHERST NY
14228-1143
US

V. Phone/Fax

Practice location:
  • Phone: 512-282-2273
  • Fax: 512-280-1446
Mailing address:
  • Phone: 716-204-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN G HOLTZCLAW
Title or Position: OWNER
Credential:
Phone: 856-686-4317