Healthcare Provider Details

I. General information

NPI: 1851958144
Provider Name (Legal Business Name): AUSTIN COMPLETE HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BEE CAVES RD STE B112
WEST LAKE HILLS TX
78746-6458
US

IV. Provider business mailing address

4201 BEE CAVES RD STE B112
WEST LAKE HILLS TX
78746-6458
US

V. Phone/Fax

Practice location:
  • Phone: 512-327-4886
  • Fax:
Mailing address:
  • Phone: 512-327-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRA HARRISON MOORE
Title or Position: OWNER
Credential: MD
Phone: 512-327-4886