MEDICARE: SOUTH AUSTIN WOMENS HEALTHCARE 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	207V00000X	Obstetrics & Gynecology Physician	M1955	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0011MW	OTHER	TX	BCBS GROUP

General Provider Information

NPI Number	:	1659480481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH AUSTIN WOMENS HEALTHCARE PA

Provider Business Mailing Address
First Line	:	PO BOX 40699
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-0012
Country	:	US
Telephone Number	:	512-326-5175
Fax Number	:	512-326-5131

Provider Business Practice Location Address
First Line	:	4316 JAMES CASEY ST
Second Line	:	SUITE B-101
City	:	AUSTIN
State	:	TX
Zip	:	78745-1116
Country	:	US
Telephone Number	:	512-326-5175
Fax Number	:	512-326-5131

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL DOUGLAS MUMFREY II
Credential	:	M.D.
Telephone Number	:	512-326-5175

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	01/04/2008

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