Provider Demographics
NPI:1336327980
Name:JOHN S MANGIONE, MD, PA
Entity Type:Organization
Organization Name:JOHN S MANGIONE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-418-1979
Mailing Address - Street 1:4106 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3722
Mailing Address - Country:US
Mailing Address - Phone:512-418-1979
Mailing Address - Fax:512-418-1943
Practice Address - Street 1:4106 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3722
Practice Address - Country:US
Practice Address - Phone:512-418-1979
Practice Address - Fax:512-418-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9769174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty