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NPI Code Detail

MEDICARE: SOUTH AUSTIN FAMILY PRACTICE CLINIC, PLLC

MEDICARE: SOUTH AUSTIN FAMILY PRACTICE CLINIC, PLLC
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
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician
3213E00000XPodiatrist
4207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11235130592OTHERTXNPI

General Provider Information

NPI Number : 1235130592
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH AUSTIN FAMILY PRACTICE CLINIC, PLLC
Provider Business Mailing Address
First Line : 2675 WINKLER AVE FL 2
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-9342
Country : US
Telephone Number : 877-856-3774
Fax Number : 239-599-2625
Provider Business Practice Location Address
First Line : 5625 EIGER RD
Second Line : SUITE 200
City : AUSTIN
State : TX
Zip : 78735-8982
Country : US
Telephone Number : 512-892-7076
Fax Number : 239-599-2625
Authorized Official
Title or Position : PRESIDENT
Name : KEVIN P SPENCER
Credential : M.D.
Telephone Number : 512-892-7076
Provider Enumeration Date : 08/09/2005
Last Update Date : 06/20/2025

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