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General NPI Number Information
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NPI Number | 1376126045
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Entity Type | Organization
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Legal Business Name | AUSTIN HEALTH WIRED, P.A.
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 3403 FOOTHILL PKWY
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City | AUSTIN
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State | TX
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Zip | 78731-5824
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Country | US
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Telephone | 512-589-5965
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W. 4TH STREET SUITE 454
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City | AUSTIN
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State | TX
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Zip | 78701
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Country | US
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Telephone | 512-589-5965
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Fax | 512-394-4694
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHARLES BASIL OWEN II
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Credential | MD
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Telephone | 512-589-5965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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