Provider Demographics
NPI:1285035972
Name:AUSTIN INTEGRATIVE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:AUSTIN INTEGRATIVE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FLUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-442-2727
Mailing Address - Street 1:PO BOX 5898
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78763-5898
Mailing Address - Country:US
Mailing Address - Phone:512-442-2727
Mailing Address - Fax:512-442-2728
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BLDG B STE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-442-2727
Practice Address - Fax:512-442-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX379263Medicare PIN