Provider Demographics
NPI:1366508418
Name:PRIMARY PHYSICIANS OF AUSTIN, P.A.
Entity Type:Organization
Organization Name:PRIMARY PHYSICIANS OF AUSTIN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:TOBIAS
Authorized Official - Last Name:BERENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-380-9441
Mailing Address - Street 1:4301 BURNET ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3317
Mailing Address - Country:US
Mailing Address - Phone:512-380-9441
Mailing Address - Fax:512-380-9410
Practice Address - Street 1:4301 BURNET RD
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3317
Practice Address - Country:US
Practice Address - Phone:512-380-9441
Practice Address - Fax:512-380-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3988261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143675001Medicaid
TX0020EVOtherBLUE CROSS GROUP #
TX00149RMedicare PIN
TX0020EVOtherBLUE CROSS GROUP #