MEDICARE: AUSTIN SOUTHWEST ORTHOPAEDIC GROUP, P.A.

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	2086S0105X	Surgery of the Hand (Surgery) Physician
2	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

General Provider Information

NPI Number	:	1699761494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN SOUTHWEST ORTHOPAEDIC GROUP, P.A.

Provider Business Mailing Address
First Line	:	7951 SHOAL CREEK BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7582
Country	:	US
Telephone Number	:	512-584-8404
Fax Number	:	512-458-2327

Provider Business Practice Location Address
First Line	:	5200 DAVIS LANE SUITE B200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749
Country	:	US
Telephone Number	:	512-451-1969
Fax Number	:	512-458-2327

Authorized Official
Title or Position	:	MD
Name	:	BRIAN L SULLIVAN
Credential	:
Telephone Number	:	512-451-1969

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	05/17/2024

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