=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437144300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUSTIN INTERNAL MEDICINE ASSOCIATES, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3407 GLENVIEW AVE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78703-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-459-3149
-----------------------------------------------------
Fax | 512-459-6974
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3407 GLENVIEW AVE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78703-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-459-3149
-----------------------------------------------------
Fax | 512-459-6974
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. ACE H ALSUP III
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 512-459-3149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------