Healthcare Provider Details

I. General information

NPI: 1437586310
Provider Name (Legal Business Name): AUSTIN CHILDREN'S CHEST ASSOCIATES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 LINKS LN SUITE 200
ROUND ROCK TX
78664-3901
US

IV. Provider business mailing address

11111 RESEARCH BLVD SUITE 300
AUSTIN TX
78759-5264
US

V. Phone/Fax

Practice location:
  • Phone: 512-380-9200
  • Fax: 512-380-9201
Mailing address:
  • Phone: 512-380-9200
  • Fax: 512-380-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: BENNIE MCWILLIAMS
Title or Position: PHYSICIAN
Credential: MD
Phone: 512-380-9200