Healthcare Provider Details

I. General information

NPI: 1477959815
Provider Name (Legal Business Name): AUSTIN FIVE STAR ER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ROUND ROCK AVENUE
ROUND ROCK TX
78681
US

IV. Provider business mailing address

6300 LA CALMA DR SUITE 200
AUSTIN TX
78752-3843
US

V. Phone/Fax

Practice location:
  • Phone: 281-209-8921
  • Fax: 281-209-8930
Mailing address:
  • Phone: 281-209-8921
  • Fax: 281-209-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL CONNER
Title or Position: CEO
Credential:
Phone: 281-209-8921