Provider Demographics
NPI:1093053373
Name:SPECIALTY CLINIC OF AUSTIN PA
Entity Type:Organization
Organization Name:SPECIALTY CLINIC OF AUSTIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIVYANSU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-376-7948
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:175
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4515 SETON CENTER PKWY
Practice Address - Street 2:175
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5290
Practice Address - Country:US
Practice Address - Phone:512-302-1954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN59342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty