MEDICARE: GEORGE M. AUSTIN, M.D. INC.

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	174400000X	Specialist	R8754	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07414054	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1669500815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE M. AUSTIN, M.D. INC.

Provider Business Mailing Address
First Line	:	206 NW MOCK AVE
Second Line	:	SUITE 200
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2507
Country	:	US
Telephone Number	:	816-224-8999
Fax Number	:	816-224-3121

Provider Business Practice Location Address
First Line	:	206 NW MOCK AVE
Second Line	:	SUITE 200
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2507
Country	:	US
Telephone Number	:	816-224-8999
Fax Number	:	816-224-3121

Authorized Official
Title or Position	:	PATIENT ACCOUNTS
Name	:	KAREN DIECKHOFF
Credential	:
Telephone Number	:	816-224-8999

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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