MEDICARE: AUSTIN INTERNAL MEDICINE 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	207R00000X	Internal Medicine Physician	E6239	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90QC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1982804274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTIN INTERNAL MEDICINE CLINIC, PA

Provider Business Mailing Address
First Line	:	1701 W BEN WHITE BLVD
Second Line	:	SUITE 140
City	:	AUSTIN
State	:	TX
Zip	:	78704-7667
Country	:	US
Telephone Number	:	512-441-8666
Fax Number	:	512-441-8698

Provider Business Practice Location Address
First Line	:	1701 W BEN WHITE BLVD
Second Line	:	SUITE 140
City	:	AUSTIN
State	:	TX
Zip	:	78704-7667
Country	:	US
Telephone Number	:	512-441-8666
Fax Number	:	512-441-8698

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TOM MARTENS
Credential	:	DO
Telephone Number	:	512-441-8666

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	04/30/2008

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