Provider Demographics
NPI:1003538182
Name:AUSTIN OAKS PHYSICAL MEDICINE PLLC
Entity Type:Organization
Organization Name:AUSTIN OAKS PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-462-9729
Mailing Address - Street 1:7718 WOOD HOLLOW DR STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1602
Mailing Address - Country:US
Mailing Address - Phone:737-304-7500
Mailing Address - Fax:737-403-7501
Practice Address - Street 1:7718 WOOD HOLLOW DR STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1602
Practice Address - Country:US
Practice Address - Phone:737-304-7500
Practice Address - Fax:737-403-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty