Healthcare Provider Details

I. General information

NPI: 1144408550
Provider Name (Legal Business Name): AUSTIN IMMEDIATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 03/29/2010
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

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

V. Phone/Fax

Practice location:
  • Phone: 512-282-2273
  • Fax:
Mailing address:
  • Phone: 512-282-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberPA02586
License Number StateTX

VIII. Authorized Official

Name: DR. JORDAN LAROE
Title or Position: MEDICAL DIRECTOR
Credential: MD.
Phone: 512-282-2273