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General NPI Number Information
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NPI Number | 1053963025
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Entity Type | Organization
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Legal Business Name | AUSTIN REGIONAL CLINIC, PA
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 2100 AUTUMN SLATE DR STE 150
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-6034
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Country | US
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Telephone | 737-220-7200
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Fax | 512-406-7339
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Provider Business Mailing Address
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Address Line | 6210 E US HWY 290 SUITE 420 - CREDENTIALING
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City | AUSTIN
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State | TX
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Zip | 78723-1098
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Country | US
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Telephone | 512-338-3802
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Fax | 512-406-6216
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ANAS DAGHESTANI
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Credential | MD
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Telephone | 512-419-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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