Provider Demographics
NPI:1376126045
Name:AUSTIN HEALTH WIRED, P.A.
Entity Type:Organization
Organization Name:AUSTIN HEALTH WIRED, P.A.
Other - Org Name:AUSTIN HEALTH WIRED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BASIL
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:512-589-5965
Mailing Address - Street 1:500 W. 4TH STREET
Mailing Address - Street 2:SUITE 454
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701
Mailing Address - Country:US
Mailing Address - Phone:512-589-5965
Mailing Address - Fax:512-394-4694
Practice Address - Street 1:3403 FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5824
Practice Address - Country:US
Practice Address - Phone:512-589-5965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty