Healthcare Provider Details

I. General information

NPI: 1013240076
Provider Name (Legal Business Name): VACCINE MACHINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 W 38TH ST STE 1
AUSTIN TX
78705-1251
US

IV. Provider business mailing address

631 W 38TH ST STE 1
AUSTIN TX
78705-1251
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-0672
  • Fax: 512-420-0974
Mailing address:
  • Phone: 512-459-0672
  • Fax: 512-420-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberE2824
License Number StateTX

VIII. Authorized Official

Name: DR. SIDNEY T ROBIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 512-459-0672