Provider Demographics
NPI:1346685344
Name:RED LOTUS ACUPUNCTURE AND ORIENTAL MEDICINE
Entity Type:Organization
Organization Name:RED LOTUS ACUPUNCTURE AND ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC.
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS ORIENTAL MEDICINE
Authorized Official - Phone:512-797-7151
Mailing Address - Street 1:6530 NEEDHAM LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8303 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7525
Practice Address - Country:US
Practice Address - Phone:512-797-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX AC00674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty