Healthcare Provider Details

I. General information

NPI: 1437493244
Provider Name (Legal Business Name): INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY OF CENTRAL TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SETON PKWY STE 402
ROUND ROCK TX
78665-8002
US

IV. Provider business mailing address

1400 N IH 35 STE 320
AUSTIN TX
78701-1926
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-4815
  • Fax: 512-324-4726
Mailing address:
  • Phone: 512-324-8320
  • Fax: 512-324-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. JAMINE ROSE PADILLA
Title or Position: SR DEPT ASSISTANT
Credential:
Phone: 512-324-8320