MEDICARE: MANN AUSTIN SURGERY SUITE LLC

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	261QS0132X	Ophthalmologic Surgery Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1962186437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANN AUSTIN SURGERY SUITE LLC

Provider Business Mailing Address
First Line	:	4314 W BRAKER LN FL 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5358
Country	:	US
Telephone Number	:	800-698-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 W BRAKER LN FL 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5358
Country	:	US
Telephone Number	:	800-698-4746
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	PAUL MICHAEL MANN
Credential	:	MD
Telephone Number	:	800-698-4746

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	09/19/2023

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