Healthcare Provider Details

I. General information

NPI: 1417161134
Provider Name (Legal Business Name): AUSTIN NEUROLOGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711-F WEST 38TH STREET
AUSTIN TX
78705-1133
US

IV. Provider business mailing address

711-F WEST 38TH STREET
AUSTIN TX
78705
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-6121
  • Fax: 512-452-9171
Mailing address:
  • Phone: 512-458-6121
  • Fax: 512-452-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE THOMAS
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 512-637-5894