Provider Demographics
NPI:1235746413
Name:AUSTIN REGIONAL CLINIC, PA
Entity Type:Organization
Organization Name:AUSTIN REGIONAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZDWNEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-231-5500
Mailing Address - Street 1:6210 E US HWY 290
Mailing Address - Street 2:SUITE 420- CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1098
Mailing Address - Country:US
Mailing Address - Phone:512-338-3802
Mailing Address - Fax:512-406-6212
Practice Address - Street 1:22420 IH 35
Practice Address - Street 2:STE 203
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2656
Practice Address - Country:US
Practice Address - Phone:737-404-0347
Practice Address - Fax:512-406-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1333940-07Medicaid