=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548762321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMANA PSYCHIATRIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2018
-----------------------------------------------------
Last Update Date | 03/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4131 SPICEWOOD SPRINGS RD STE L2
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-8652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-521-6189
-----------------------------------------------------
Fax | 512-521-6189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11516 EAGLES GLEN DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78732-2089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-521-6189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ASIF MUHAMMAD SIDDIQUI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 512-521-6189
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | L0600
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------