Provider Demographics
NPI:1073510574
Name:DEPENDACARE OF AUSTIN
Entity Type:Organization
Organization Name:DEPENDACARE OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-944-9916
Mailing Address - Street 1:5321 INDUSTRIAL OAKS BLVD
Mailing Address - Street 2:SUITE # 121
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8822
Mailing Address - Country:US
Mailing Address - Phone:512-892-0405
Mailing Address - Fax:512-892-0431
Practice Address - Street 1:5321 INDUSTRIAL OAKS BLVD
Practice Address - Street 2:SUITE # 121
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8822
Practice Address - Country:US
Practice Address - Phone:512-892-0405
Practice Address - Fax:512-892-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0071814332BC3200X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1662496-01Medicaid
TX1662496-01Medicaid