Provider Demographics
NPI:1154456440
Name:AUSTIN I OGWU, MD PA
Entity Type:Organization
Organization Name:AUSTIN I OGWU, MD PA
Other - Org Name:ALPHA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:OGWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-230-8290
Mailing Address - Street 1:2505 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1930
Mailing Address - Country:US
Mailing Address - Phone:972-230-8290
Mailing Address - Fax:972-230-8274
Practice Address - Street 1:2505 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1930
Practice Address - Country:US
Practice Address - Phone:972-230-8290
Practice Address - Fax:972-230-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159966401Medicaid
TX5524910001Medicare NSC