MEDICARE: AUSTIN DIAGNOSTIC CLINIC, PA

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	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588638548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN DIAGNOSTIC CLINIC, PA

Provider Business Mailing Address
First Line	:	12221 MOPAC EXPRESSWAY N
Second Line	:	DEPT OF ORTHOPAEDIC SURGERY
City	:	AUSTIN
State	:	TX
Zip	:	78758-2483
Country	:	US
Telephone Number	:	512-901-4015
Fax Number	:	512-901-3915

Provider Business Practice Location Address
First Line	:	12221 MOPAC EXPRESSWAY N
Second Line	:	DEPT OF ORTHOPAEDIC SURGERY
City	:	AUSTIN
State	:	TX
Zip	:	78758-2483
Country	:	US
Telephone Number	:	512-901-4015
Fax Number	:	512-901-3915

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	ELLEN M ANDREW
Credential	:
Telephone Number	:	512-901-4937

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/15/2010

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Directions to “AUSTIN DIAGNOSTIC CLINIC, PA ” Practice Location

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