Healthcare Provider Details

I. General information

NPI: 1245612225
Provider Name (Legal Business Name): THE UNIVERSITY OF TEXAS AT AUSTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 ROSS RD #H
DEL VALLE TX
78617-3288
US

IV. Provider business mailing address

2901 N IH 35 # 1.301
AUSTIN TX
78722-2322
US

V. Phone/Fax

Practice location:
  • Phone: 512-386-3335
  • Fax: 512-386-3333
Mailing address:
  • Phone: 512-232-3727
  • Fax: 512-471-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number845473
License Number StateTX

VIII. Authorized Official

Name: MS. CARA GREEN
Title or Position: PRACTICE MANAGER
Credential: CPPM
Phone: 512-232-3727