Provider Demographics
NPI:1235100074
Name:AUSTIN ENDOSCOPY CENTER I, LP
Entity Type:Organization
Organization Name:AUSTIN ENDOSCOPY CENTER I, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:512-420-0186
Mailing Address - Street 1:8015 SHOAL CREEK BLVD
Mailing Address - Street 2:300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8066
Mailing Address - Country:US
Mailing Address - Phone:512-371-1519
Mailing Address - Fax:512-371-3131
Practice Address - Street 1:8015 SHOAL CREEK BLVD
Practice Address - Street 2:300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8066
Practice Address - Country:US
Practice Address - Phone:512-371-1519
Practice Address - Fax:512-371-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXASC112261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC112Medicare PIN