Provider Demographics
NPI:1225407760
Name:AUSTIN FIVE STAR ER, P.A.
Entity Type:Organization
Organization Name:AUSTIN FIVE STAR ER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOSKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-452-8533
Mailing Address - Street 1:6300 LA CALMA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3843
Mailing Address - Country:US
Mailing Address - Phone:512-452-8533
Mailing Address - Fax:281-209-8930
Practice Address - Street 1:21315 N. SH 130
Practice Address - Street 2:BLDG. 4
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660
Practice Address - Country:US
Practice Address - Phone:512-452-8533
Practice Address - Fax:281-209-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00M5M7OtherBCBS