MEDICARE: AUSTIN REGIONAL 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	332B00000X	Durable Medical Equipment & Medical Supplies

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

General Provider Information

NPI Number	:	1679878391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN REGIONAL CLINIC, PA

Provider Business Mailing Address
First Line	:	6210 E US HWY 290
Second Line	:	SUITE 420 - CREDENTIALING
City	:	AUSTIN
State	:	TX
Zip	:	78723-1098
Country	:	US
Telephone Number	:	512-338-3802
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	1807 SLAUGHTER LN
Second Line	:	SUITE 490
City	:	AUSTIN
State	:	TX
Zip	:	78748-6237
Country	:	US
Telephone Number	:	512-282-8967
Fax Number	:	512-406-7351

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	ANAS DAGHESTANI
Credential	:	MD
Telephone Number	:	512-231-5500

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	02/20/2019

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