Provider Demographics
NPI:1326218751
Name:KALIN KELSO MD PA
Entity Type:Organization
Organization Name:KALIN KELSO MD PA
Other - Org Name:AUSTIN ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KALIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-339-0440
Mailing Address - Street 1:2200 PARK BEND DR
Mailing Address - Street 2:BLDG 1 STE 301
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5387
Mailing Address - Country:US
Mailing Address - Phone:512-339-0440
Mailing Address - Fax:512-339-0454
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:STE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-339-0440
Practice Address - Fax:512-339-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4259207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z076Medicare PIN
TX6147150001Medicare NSC