MEDICARE: ASCEND MEDICAL AUSTIN TEXAS II 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1710651799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCEND MEDICAL AUSTIN TEXAS II PA

Provider Business Mailing Address
First Line	:	3560 LENOX RD NE STE 1230
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-4266
Country	:	US
Telephone Number	:	888-250-5708
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 LAS CIMAS PKWY STE 250
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-6595
Country	:	US
Telephone Number	:	404-947-8066
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	MICHELLE JUSTICE
Credential	:
Telephone Number	:	678-500-8010

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	03/02/2022

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