Provider Demographics
NPI:1215204540
Name:PREMIER GYNECOLOGY OF AUSTIN
Entity Type:Organization
Organization Name:PREMIER GYNECOLOGY OF AUSTIN
Other - Org Name:PREMIER INTEGRATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCREVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-459-4405
Mailing Address - Street 1:1010 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4924
Mailing Address - Country:US
Mailing Address - Phone:512-459-4405
Mailing Address - Fax:
Practice Address - Street 1:1010 W 9TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4924
Practice Address - Country:US
Practice Address - Phone:512-459-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty