Provider Demographics
NPI:1144408550
Name:AUSTIN IMMEDIATE CARE
Entity Type:Organization
Organization Name:AUSTIN IMMEDIATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-282-2273
Mailing Address - Street 1:5000 W SLAUGHTER LN
Mailing Address - Street 2:BLDG. 6, SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3997
Mailing Address - Country:US
Mailing Address - Phone:512-282-2273
Mailing Address - Fax:
Practice Address - Street 1:5000 W SLAUGHTER LN
Practice Address - Street 2:BLDG. 6, SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3997
Practice Address - Country:US
Practice Address - Phone:512-282-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02586261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXUPIN-S92401Medicaid
TXPIN85N729Medicare PIN
TXUPIN-S92401Medicaid