=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699761494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUSTIN SOUTHWEST ORTHOPAEDIC GROUP, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 05/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5200 DAVIS LANE SUITE B200
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-451-1969
-----------------------------------------------------
Fax | 512-458-2327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7951 SHOAL CREEK BLVD STE 300
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-7582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-584-8404
-----------------------------------------------------
Fax | 512-458-2327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | BRIAN L SULLIVAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-451-1969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0105X
-----------------------------------------------------
Taxonomy Name | Surgery of the Hand (Surgery) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------