MEDICARE: LOUSTED AUSTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1073054417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUSTED AUSTIN

Provider Business Mailing Address
First Line	:	3404 MONTE VISTA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-5723
Country	:	US
Telephone Number	:	512-715-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 MONTE VISTA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-5723
Country	:	US
Telephone Number	:	512-715-4824
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MICHELLE SUNSHINE
Credential	:
Telephone Number	:	512-465-1998

Provider Enumeration Date	:	03/18/2017
Last Update Date	:	03/18/2017

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