Provider Demographics
NPI:1033552443
Name:AUSTIN PROSTHETIC CENTER, INC
Entity Type:Organization
Organization Name:AUSTIN PROSTHETIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-202-1550
Mailing Address - Street 1:1005 EAST SAINT ELMO ROAD
Mailing Address - Street 2:BLDG 9
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745
Mailing Address - Country:US
Mailing Address - Phone:512-937-9310
Mailing Address - Fax:855-630-9574
Practice Address - Street 1:1005 E SAINT ELMO RD BLDG 9
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1233
Practice Address - Country:US
Practice Address - Phone:512-937-9310
Practice Address - Fax:855-630-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101427335E00000X
TX335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6796520001Medicare UPIN