Provider Demographics
NPI:1033359534
Name:HEART CLINIC OF AUSTIN, PA
Entity Type:Organization
Organization Name:HEART CLINIC OF AUSTIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-945-8888
Mailing Address - Street 1:11673 JOLLYVILLE RD
Mailing Address - Street 2:STE 205 B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4200
Mailing Address - Country:US
Mailing Address - Phone:512-345-8888
Mailing Address - Fax:512-345-4278
Practice Address - Street 1:11673 JOLLYVILLE RD
Practice Address - Street 2:STE 205 B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4200
Practice Address - Country:US
Practice Address - Phone:512-345-8888
Practice Address - Fax:512-345-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0125207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A3511Medicare PIN
TX8F20789Medicare PIN